Influence of Exhalation Valve and Nebulizer Position on Albuterol Delivery During Noninvasive Positive Pressure Ventilation

Dai, Bing; Kang, Jian; Sun, Lei; Tan, Wei; Zhao, Hongwen

doi:10.1089/jamp.2012.1024

Cited by 39 publications

(38 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1 Recent studies report a marked variability in nebulization techniques and devices used. In addition, the fraction of the drug dose actually delivered has been shown to depend on many factors, including nebulizing device, 2 nebulizer position in the delivery circuit, 3,4 minute ventilation, and breathing pattern. 2,[4][5][6] During spontaneous breathing in pa-tients with tracheostomy, different combinations of corrugated tubing and capping have been studied to act as a reservoir for aerosol droplets, to maximize albuterol delivery in children 2 and adults.…”

Section: Introductionmentioning

confidence: 99%

Effects of Nebulizer Position, Gas Flow, and CPAP on Aerosol Bronchodilator Delivery: An In Vitro Study

et al. 2015

View full text Add to dashboard Cite

BACKGROUND: The aim of this study was to investigate the effects of different delivery circuit configurations, nebulizer positions, CPAP levels, and gas flow on the amount of aerosol bronchodilator delivered during simulated spontaneous breathing in an in vitro model. METHODS: A pneumatic lung simulator was connected to 5 different circuits for aerosol delivery, 2 delivering CPAP through a high-flow generator tested at 30, 60, and 90 L/min supplementary flow and 5, 10, and 15 cm H 2 O CPAP and 3 with no CPAP: a T-piece configuration with one extremity closed with a cap, a T-piece configuration without cap and nebulizer positioned proximally, and a T-piece configuration without cap and nebulizer positioned distally. Albuterol was collected with a filter, and the percentage amount delivered was measured by infrared spectrophotometry. RESULTS: Configurations with continuous high-flow CPAP delivered higher percentage amounts of albuterol compared with the configurations without CPAP (9.1 ؎ 6.0% vs 6.2 ؎ 2.8%, P ‫؍‬ .03). Among configurations without CPAP, the best performance was obtained with a T-piece with one extremity closed with a cap. In CPAP configurations, the highest delivery (13.8 ؎ 4.4%) was obtained with the nebulizer placed proximal to the lung simulator, independent of flow. CPAP at 15 cm H 2 O resulted in the highest albuterol delivery (P ‫؍‬ .02). CONCLUSIONS: Based on our in vitro study, without CPAP, a T-piece with a cap at one extremity maximizes albuterol delivery. During high-flow CPAP, the nebulizer should always be placed proximal to the patient, after the T-piece, using the highest CPAP clinically indicated.

show abstract

Section: Introductionmentioning

confidence: 99%

Effects of Nebulizer Position, Gas Flow, and CPAP on Aerosol Bronchodilator Delivery: An In Vitro Study

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Of 5 previous studies [8, 9, 11-13] (Table 1), 1 reported that the proximal position gave higher delivery [9], 2 reported that the distal position had higher delivery [12, 13], and the other 2 studies gave inconsistent results [8, 11]. These discrepancies may be partly explained by differences in the distance between the nebulizer position and the exhalation valve in different studies, as well as the differences in experimental conditions used (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…The inspiratory and expiratory pressures were set at 15/5, 25/5, 15/10, and 25/10 cm H 2 0. The exhalation valve used was either a single-arch exhalation port or a whisper swivel (both Respironics; for more detailed descriptions of the valves see [8]).…”

Section: Methodsmentioning

confidence: 99%

“…The effect of the nebulizer position is particularly complicated [6]. While most current investigators advocate using a nebulizer position at the distal end of the breathing circuit, between the exhalation valve and the patient [7], some studies have found that a nebulizer position at the proximal end of the breathing circuit, between the exhalation valve and the ventilator, can increase aerosol inhalation efficiency [8, 9]. This inconsistency may be related to the different distances between the nebulizer position and the exhalation valve used in the different studies, where too short a distance from the nebulizer to the exhalation valve may cause excessive leakage of the aerosol through the exhalation valve, and too long a distance from the nebulizer to the valve (that is, a position closer to the ventilator) may cause excessive loss of the aerosol in the breathing circuit or aerosol reflux inside the ventilator.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Which Nebulizer Position Should Be Avoided? An Extended Study of Aerosol Delivery and Ventilator Performance during Noninvasive Positive Pressure Ventilation

Peng¹,

Dai²,

Hu³

et al. 2017

Respiration

Self Cite

View full text Add to dashboard Cite

Background: Research on the effect of nebulizer location on aerosol delivery during noninvasive ventilation has reached inconsistent conclusions. Objective: To investigate the effects of nebulizer position on aerosol delivery efficiency and ventilator performance during noninvasive ventilation. Methods: The Active Servo Lung 5000 respiratory simulation system (ASL5000) was used to simulate a COPD patient. The noninvasive ventilator was set to the spontaneous breathing mode. Six nebulizer positions, 2 exhalation valve types (single-arch exhalation port and whisper swivel), 4 combinations of inspiratory and expiratory pressure, and 2 respiratory rates were used. Results: Significant differences between nebulizer positions existed in aerosol delivery (p < 0.05). Aerosol delivery efficiency was lower for nebulizer locations on either side of the exhalation valve and next to the ventilator outlet. When the nebulizer was located between the exhalation valve and the simulated lung, increased inspiratory pressure increased and increased expiratory pressure decreased delivery efficiency (both p < 0.05). When the nebulization device was located between the exhalation valve and the ventilator, no obvious trend was observed. Compared to baseline, nebulization lowered the air leakage volume displayed on the ventilator. There were no differences in ventilator performance between different nebulizer positions. Conclusions: The closer the nebulizer was to the exhalation valves or ventilator, the lower the aerosol delivery efficiency. Nebulizer position had little clinically significant effect on ventilator performance.

show abstract

“…Other studies have found that bias flow and exhalation-valve function influence aerosol delivery, so each CPAP or noninvasive ventilation driver may have a different aerosol delivery profile. 20,21 The second important finding from Farney et al is that, regardless of the nebulizer location, there was substantial aerosol deposition in the generator tubing and in the CPAP generator, which serves also as a patient interface. This part of the ventilator tubing plays a role in generating pressure as well as improving exhalation (via the Coanda effect), which decreases the work of breathing.…”

mentioning

confidence: 99%

Aerosol Administration During Nasal CPAP in Newborns Can Be Optimized

Mazela

2014

Respir Care

View full text Add to dashboard Cite

Influence of Exhalation Valve and Nebulizer Position on Albuterol Delivery During Noninvasive Positive Pressure Ventilation

Cited by 39 publications

References 18 publications

Effects of Nebulizer Position, Gas Flow, and CPAP on Aerosol Bronchodilator Delivery: An In Vitro Study

Effects of Nebulizer Position, Gas Flow, and CPAP on Aerosol Bronchodilator Delivery: An In Vitro Study

Which Nebulizer Position Should Be Avoided? An Extended Study of Aerosol Delivery and Ventilator Performance during Noninvasive Positive Pressure Ventilation

Aerosol Administration During Nasal CPAP in Newborns Can Be Optimized

Contact Info

Product

Resources

About