SPECT-CT Comparison of Lung Deposition using a System combining a Vibrating-mesh Nebulizer with a Valved Holding Chamber and a Conventional Jet Nebulizer: a Randomized Cross-over Study

Dugernier, Jonathan; Hesse, Michel; Vanbever, Rita; Depoortere, Virginie; Roeseler, Jean; Michotte, Jean-Bernard; Laterre, Pierre‐François; Jamar, François; Reychler, Grégory

doi:10.1007/s11095-016-2061-7

Cited by 58 publications

(51 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While efficient bronchodilation was observed with such doses [ 51 , 52 ], reaching therapeutic levels of antibiotics may be more challenging. These values are low in comparison with that reported in spontaneously breathing patients using similar models of jet or vibrating-mesh nebulizer (15 − 35% ND) [ 53 – 56 ]. Historically, mechanical ventilation has been considered to be a barrier to drug delivery [ 17 , 29 ].…”

Section: Discussioncontrasting

confidence: 65%

Aerosol delivery during invasive mechanical ventilation: a systematic review

Dugernier

Ehrmann

Sottiaux³

et al. 2017

Crit Care

Self Cite

View full text Add to dashboard Cite

BackgroundThis systematic review aimed to assess inhaled drug delivery in mechanically ventilated patients or in animal models. Whole lung and regional deposition and the impact of the ventilator circuit, the artificial airways and the administration technique for aerosol delivery were analyzed.MethodsIn vivo studies assessing lung deposition during invasive mechanical ventilation were selected based on a systematic search among four databases. Two investigators independently assessed the eligibility and the risk of bias.ResultsTwenty-six clinical and ten experimental studies were included. Between 30% and 43% of nominal drug dose was lost to the circuit in ventilated patients. Whole lung deposition of up to 16% and 38% of nominal dose (proportion of drug charged in the device) were reported with nebulizers and metered-dose inhalers, respectively. A penetration index inferior to 1 observed in scintigraphic studies indicated major proximal deposition. However, substantial concentrations of antibiotics were measured in the epithelial lining fluid (887 (406–12,819) μg/mL of amikacin) of infected patients and in sub-pleural specimens (e.g., 197 μg/g of amikacin) dissected from infected piglets, suggesting a significant distal deposition. The administration technique varied among studies and may explain a degree of the variability of deposition that was observed.ConclusionsLung deposition was lower than 20% of nominal dose delivered with nebulizers and mostly occurred in proximal airways. Further studies are needed to link substantial concentrations of antibiotics in infected pulmonary fluids to pulmonary deposition. The administration technique with nebulizers should be improved in ventilated patients in order to ensure an efficient but safe, feasible and reproducible technique.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1844-5) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussioncontrasting

confidence: 65%

Aerosol delivery during invasive mechanical ventilation: a systematic review

Dugernier

Ehrmann

Sottiaux³

et al. 2017

Crit Care

Self Cite

View full text Add to dashboard Cite

show abstract

“…Prior to our project no clinical outcome comparisons between VMN and JN had been reported. However, scintigraphy data had suggested greater efficiency of drug delivery associated with the VMN as compared to JN [1,7]. A review of various meta-analyses and RCTs (involving 394 trials) comparing clinical outcomes of inhaled drugs (beta agonist, anticholinergic and corticosteroid) with nebulizers, pMDI, pMDI with spacer and DPI (dry powder inhalers) showed no difference between devices in efficacy outcomes in any patient group, including the ED [8].…”

Section: Discussionmentioning

confidence: 99%

“…Based on these studies demonstrating greater efficiency of drug delivery, we expected that a higher dose of bronchodilator would be delivered in patients with acute respiratory distress with the VMN [1,5,7]. This project was designed to help evaluate a new nebulizer that the hospital was considering expanding the use of.…”

Section: Introductionmentioning

confidence: 99%

Comparison of bronchodilator administration with vibrating mesh nebulizer and standard jet nebulizer in the emergency department

Dunne

Shortt

2018

The American Journal of Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…7,24 However, the main effect of the holding chamber is not to decrease the particle size of the aerosolized medication but to hold the nebulized aerosol from release to the surrounding area. 26 The urinary data from the in vivo study showed similar results. The Solo-holding chamber significantly increased the amount of drug excreted over a 24-h period after inhalation by 1.8-fold (P ϭ .02) and the amount of drug excreted in the first 30 min by 1.3-fold (P ϭ .034) compared with the Solo-T-piece.…”

Section: Discussionmentioning

confidence: 55%