Pulmonary Drug Delivery Following Continuous Vibrating Mesh Nebulization and Inspiratory Synchronized Vibrating Mesh Nebulization During Noninvasive Ventilation in Healthy Volunteers

Abstract

During NIPPV with a single-limb circuit bilevel ventilator, the use of inspiratory synchronized vibrating mesh nebulization may improve pulmonary drug delivery compared with conventional continuous vibrating mesh nebulization.

In vitro comparison between inspiration synchronized and continuous vibrating mesh nebulizer during trans-nasal aerosol delivery

“…Compared to the current commercially available continuous VMN, the inspiration synchronized VMN did not generate clinically relevant increment of inhaled dose, particularly at high gas flows. However, this finding was not surprising, as the inhaled dose was only slightly higher with inspiration synchronized VMN than continuous VMN in the previous in vitro and in vivo adult studies during noninvasive ventilation [11,12], while the inhaled dose was found to be even lower with inspiration synchronized VMN than continuous VMN during neonatal invasive ventilation in both in vitro and in vivo studies [23,24]. Additionally, all these studies found the delivery time with inspiration synchronized VMN was two-to threefold longer than continuous VMN [11,12,23,24].…”

“…However, this finding was not surprising, as the inhaled dose was only slightly higher with inspiration synchronized VMN than continuous VMN in the previous in vitro and in vivo adult studies during noninvasive ventilation [11,12], while the inhaled dose was found to be even lower with inspiration synchronized VMN than continuous VMN during neonatal invasive ventilation in both in vitro and in vivo studies [23,24]. Additionally, all these studies found the delivery time with inspiration synchronized VMN was two-to threefold longer than continuous VMN [11,12,23,24]. As such, the authors argued if it was worthwhile to use inspiration synchronized VMN [11,12,23,24].…”

“…Additionally, all these studies found the delivery time with inspiration synchronized VMN was two-to threefold longer than continuous VMN [11,12,23,24]. As such, the authors argued if it was worthwhile to use inspiration synchronized VMN [11,12,23,24].…”

“…The technique of synchronizing aerosol production with patient's inspiratory effort is available in small volume jet nebulizer, which shows threefold increase of inhaled aerosol mass over the conventional continuous jet nebulizer [10]. Michotte et al integrated this algorithm into VMN and compared its efficiency with continuous VMN during noninvasive ventilation; both in vitro and in vivo studies found that inspiration synchronized VMN produced higher lung dosage than continuous VMN [11,12]. However, little has been known about inspiration synchronized aerosol via HFNC.…”

A narrative review on trans-nasal pulmonary aerosol delivery

“…Continuous generation of aerosol by nebulizers JN or VMN, in-line with HFNC, results in wastage to the atmosphere during the expiratory phase. Synchronized aerosol generation with patient’s spontaneous breathing increases inhaled dose during both invasive [ 53 ] and noninvasive ventilation [ 54 , 55 ]. With a prototype breath-synchronized VMN, Li and colleagues reported inhaled dose was higher with breath-synchronized versus continuous aerosol generation when placed close to the patient with HFNC gas flow ≥ 10 L/min.…”