Innovation in Aerosol Drug Delivery During Adult Mechanical Ventilation

Berlinski, Ariel

doi:10.4187/respcare.08470

Cited by 5 publications

(1 citation statement)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[ 2 11 32 ] Positioning the aerosol-generating device at 80 cm away from the Y-junction in a jet nebulizer and 15 cm in an ultrasonic or VMN nebulizer shows better efficacy; this effect is of much more significance in antimicrobials rather than bronchodilators. [ 12 45 46 ] The bactericidal effect of antibiotics such as tobramycin and polymyxins is concentration-dependent even in aerosolized form, and this can be achieved by maximizing the bolus effect. [ 7 ] Positioning the aerosol-generating device away from the Y-junction, coupled with continuous nebulization, can lead to maximum aerosol accumulation in the inspiratory limb and a maximum bolus effect during the inspiratory phase of the next breath, increasing the efficacy of antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Aerosol drug therapy in critically ill patients (Aero-in-ICU study): A multicentre prospective observational cohort study

Singhal,

Gurjar,

Sahoo

et al. 2024

Lung India

View full text Add to dashboard Cite

Background: In recent years, a significant understanding of delivering optimal aerosol therapy and the availability of various drugs and devices have led to an increase in its use in clinical practice. There are only a few studies available regarding their use in critically ill patients from a few parts of the world. We aimed to study the practice pattern of aerosol therapy in critically ill patients from Indian intensive care units (ICUs). Methods: After ethical approval, this multi-centric prospective observational study was performed over a study period of four weeks. Newly admitted adult patients considered who had an artificial airway and/or ventilation (including non-invasive). Patients were followed up for the next 14 days or until ICU discharge/death (whichever came first) for details of each aerosol therapy, including ongoing respiratory support, drug type, and aerosol-generating device. Results: From the nine participating centers across India, 218 patients were enrolled. Of 218 enrolled patients, 72.48% received 4884 aerosols with 30.91 ± 27.15 (95%CI: 26.6-35.1) aerosols per patient over 1108 patient days. Approximately 62.7% during IMV, 30.2% during NIV, 2.3% in spontaneously breathing patients with an artificial airway during weaning, and 4.7% were given without an artificial airway after weaning or decannulation. In 59%, a single drug was used, and bronchodilators were the most frequent. The jet nebulizer was the most common, followed by the ultrasonic and vibrating mesh aerosol generator. The ventilator setting was changed in only 6.6% of the aerosol sessions with IMV and none with NIV. Conclusion: Aerosol therapy is frequently used with a wide variation in practices; bronchodilators are the most commonly used drugs, and jet nebulizers are the most widely used.

show abstract

Section: Discussionmentioning

confidence: 99%

Aerosol drug therapy in critically ill patients (Aero-in-ICU study): A multicentre prospective observational cohort study

Singhal,

Gurjar,

Sahoo

et al. 2024

Lung India

View full text Add to dashboard Cite

show abstract

An Automated Jet Nebulizer with Dynamic Flow Regulation

2021

View full text Add to dashboard Cite

Purpose The present study is focused on designing an automated jet nebulizer that possesses the capability of dynamic flow regulation. In the case of existing equipment, 50% of the aerosol is lost to the atmosphere through the vent, during the exhalation phase of respiration. Desired effects of nebulization may not be achieved by neglecting this poor administration technique. There may be adverse effects like bronchospasm and exposure to high drug concentrations. Methods The proposed nebulizer is composed of two modes as “Compressed Air” mode and the “Oxygen Therapy” mode. The automated triggering from one mode to another will be dependent upon the percentage of oxygen saturation of the patient, monitored from the SpO 2 sensor. The compressed airflow will be delivered to the patient according to the minute ventilation, derived with the aid of a temperature sensor–based algorithm. The compressor controller circuitry ensures that the patient receives optimum level of compressed air as per the flow rate. At the end of the drug delivery, if the liquid level sensor detects the absence of medication within the nebulizer chamber, the nebulization process will be terminated. The dynamic regulation of the motor speed with respect to the minute ventilation was accomplished. Results A laminar flow was obtained from the outlet of the compressor towards the nebulizer tubing, and a turbulent flow was obtained within the chamber. No excessive turbulent flows or rotational flow patterns were detected. Conclusion Detecting the drug levels in the nebulizing chamber will prevent continuous workup and useful in situations where back-to-back nebulization is required. Oxygen therapy mode identifies the patient’s desaturation and important where the patient can be already hypoxic or have a ventilation-perfusion mismatch, but may be disadvantageous in severe COPD patients. The aforesaid results could certainly lead to the improvements of the existing nebulizers.

show abstract