The Impact of Head Model Choice on the In Vitro Evaluation of Aerosol Drug Delivery

Gallagher, Lauren; Joyce, Mary; Murphy, Barry; Eain, Marc Mac Giolla; MacLoughlin, Ronan

doi:10.3390/pharmaceutics14010024

Cited by 8 publications

(5 citation statements)

References 32 publications

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“…Collection of aerosol on a filter distal to the trachea represents the aerosol entering the lungs but does not allow for the small proportion of exhaled aerosol observed in vivo , consequently overestimating lung delivery in vivo , but serving as an accepted method to compare the effects of different conditions. It has been found that representative head model choice can significantly affect aerosol delivery [ 11 ]; thus, future studies are required to investigate how this combinational approach to aerosol therapy would affect aerosol deposition in vivo with, for example, scintigraphy studies. Supplemental oxygen is often used to deliver therapeutics to patients with exacerbations of COPD or asthma.…”

Section: Discussionmentioning

confidence: 99%

“…Experimental Set Up Both gas and aerosol via HFNO and LFNO were delivered through nasal cannula placed in the nares of an anatomically correct 3D printed adult head model, detailed by Gallagher et al 2021 [11]. Concurrent aerosol was administered via a mouthpiece with a valved aerosol holding chamber (Aerogen Ultra, Aerogen Ltd., Ireland) and VMN.…”

Section: 2mentioning

confidence: 99%

“…Critical care physicians vary on the administration of aerosol to patients on HFNO, with 33% interrupting HFNO to administer aerosol, 40% delivered aerosol concurrently with HFNO, most placing nebuliser with face mask over the cannula, and 24% placed the nebuliser within the HFNO circuit [ 9 ]. Previous studies have shown that mouthpiece-mediated delivery results in higher levels of aerosol drug delivery compared to either a face mask [ 10 ] or nasal cannula [ 11 , 12 ]. Previous reports suggest that use of an aerosol mask placed over HFNO greatly reduced aerosol delivery compared to nebuliser with mask alone; however interruption of HFNO can seriously compromise patient oxygenation [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of aerosol drug delivery with concurrent low- and high-flow nasal oxygen

et al. 2022

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Question addressed by studyAdministration of aerosol to patients receiving high flow nasal oxygen (HFNO) ranges from concurrent aerosol delivery by mouthpiece to aerosol via cannula alone. This study examines the conditions to provide optimal aerosol delivery with low or high flow nasal oxygen with concurrent mouthpiece or through nasal cannula alone, and the impact on fugitive aerosols.Materials and MethodsA vibrating mesh nebulizer delivered salbutamol via mouthpiece, aerosol holding chamber and nasal cannula to an adult head model simulating relaxed breathing. The inhaled dose (%) (mean±sd) was assayed from a filter distal to the trachea. Optical particle sizers were used to measure fugitive aerosol concentrations during aerosol delivery.ResultsConcurrent low flow nasal oxygen (LFNO) and aerosol delivery with a mouthpiece and aerosol holding chamber increased the inhaled dose (%) available, 31.44±1.33% when supplemented with 2 LPM of nasal oxygen. Concurrent HFNO above 30 LPM resulted in a lower inhaled dose (%) compared to aerosol delivered through HFNO alone. The addition of concurrent low or high flow nasal oxygen resulted in no increase in aerosol levels in the test room.Answer to question posedConcurrent low flow nasal oxygen with a mouthpiece and aerosol holding chamber is an effective and safe means of aerosol delivery.

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Section: Discussionmentioning

confidence: 99%

Section: 2mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of aerosol drug delivery with concurrent low- and high-flow nasal oxygen

et al. 2022

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“…It has long been accepted that as the supplemental gas flow rate increases, the quantity of aerosol available at the lungs decreases [ 13 , 19 , 21 , 29 ]. The differences in reported values between this study, from 0.38 ± 0.09% to 15.99 ± 0.71% adult and from 0.52 ± 0.26% to 4.07 ± 0.45% paediatric, and others can be attributed to differences in the breathing pattern [ 25 , 30 ], head model [ 35 ], HFNO system [ 16 ] and cannula sizes [ 36 ]. However, the findings presented in this work, for both models irrespective of lung health, follow the same trends as these and numerous other published works.…”

Section: Discussionmentioning

confidence: 81%

In-Line Aerosol Therapy via Nasal Cannula during Adult and Paediatric Normal, Obstructive, and Restrictive Breathing

Mac Giolla Eain,

MacLoughlin

2023

Pharmaceutics

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High-flow nasal oxygen therapy is being increasingly adopted in intensive and home care settings. The concurrent delivery of aerosolised therapeutics allows for the targeted treatment of respiratory illnesses. This study examined in-line aerosol therapy via a nasal cannula to simulated adult and paediatric models with healthy, obstructive and restrictive lung types. The Aerogen Solo vibrating mesh nebuliser was used in combination with the InspiredTM O2FLO high-flow therapy system. Representative adult and paediatric head models were connected to a breathing simulator, which replicated several different states of lung health. The aerosol delivery was quantified at the tracheal level using UV-spectrophotometry. Testing was performed at a range of supplemental gas flow rates applicable to both models. Positive end-expiratory pressure was measured pre-, during and post-nebulisation. The increases in supplemental gas flow rates resulted in a decrease in aerosol delivery, irrespective of lung health. Large tidal volumes and extended inspiratory phases were associated with the greatest aerosol delivery. Gas flow to inspiratory flow ratios of 0.29–0.5 were found to be optimum for aerosol delivery. To enhance aerosol delivery to patients receiving high-flow nasal oxygen therapy, respiratory therapists should keep supplemental gas-flow rates below the inspiratory flow of the patient.

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“…A previously described airway model of the adult nose–throat region was used as the adult model ( 17 ).…”

Section: Methodsmentioning

confidence: 99%

In vitro model for investigating aerosol dispersion in a simulated COVID-19 patient during high-flow nasal cannula treatment

et al. 2022

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The use of high-flow nasal cannula in the treatment of COVID-19 infected patients has proven to be a valuable treatment option to improve oxygenation. Early in the pandemic, there were concerns for the degree of risk of disease transmission to health care workers utilizing these treatments that are considered aerosol generating procedures. This study developed an in vitro model to examine the release of simulated patient-derived bioaerosol with and without high-flow nasal cannula at gas flow rates of 30 and 50 L/min. Aerosol dispersion was evaluated at 30 and 90 cm distances. Reduction of transmission risk was assessed using a surgical facemask on the manikin. Results indicated that the use of a facemask facilitated a 94–95% reduction in exhaled aerosol concentration at 30 cm and 22–60% reduction for 90 cm distance across both gas flow rates. This bench study confirms that this in vitro model can be used as a tool to assess the risk of disease transmission during aerosol generating procedures in a simulated patient and to test factors to mitigate the risk.

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The Impact of Head Model Choice on the In Vitro Evaluation of Aerosol Drug Delivery

Cited by 8 publications

References 32 publications

Evaluation of aerosol drug delivery with concurrent low- and high-flow nasal oxygen

Evaluation of aerosol drug delivery with concurrent low- and high-flow nasal oxygen

In-Line Aerosol Therapy via Nasal Cannula during Adult and Paediatric Normal, Obstructive, and Restrictive Breathing

In vitro model for investigating aerosol dispersion in a simulated COVID-19 patient during high-flow nasal cannula treatment

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