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

Peng, Yun; Dai, Bing; Hu, Chunxiang; Su, Jia; Tan, Wei; Zhao, Hongwen; Kang, Jian

doi:10.1159/000481868

Cited by 10 publications

(9 citation statements)

References 21 publications

(28 reference statements)

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“…These results are in contrast to the overall consensus of the current literature, which suggests placement of the nebulizer between the leak port and the mask; however, testing in the literature was performed without a mask leak. [1][2][3][4][5][6]13,14 Prior studies focused on the singular effects of the leak port instead of its combined effects with a mask leak. The incorporation of a mask leak in NIV changes the dynamics of aerosol delivery: higher mask leak causes increased flow in the circuit and decreased aerosol losses via the leak port.…”

Section: Discussionmentioning

confidence: 99%

“…The profile of the negative inspiratory pressure generated by the ASL 5000 at the start of a breath was created by setting 5% of respiratory cycle time to active inspiration, 3% to end-inspiratory hold, and 15% to return of pressure to baseline. 3 A noninvasive circuit without humidification and with a "Leak 1" exhalation port (582073, Philips Respironics), was attached to a mediumsized NIV oronasal mask (AF531, Philips Respironics) that was fitted to a rigid plastic adult mannequin head (Fisher and Paykel Healthcare, Auckland, New Zealand) with a 22-mm inner diameter airway opening at the mouth position. Tapered probes were inserted underneath the mask cushion, between the mask and mannequin face ( Fig.…”

Section: Methodsmentioning

confidence: 99%

“…Conventional noninvasive ventilators have a single limb circuit with an uncontrolled leak port, which is an obvious source of aerosol losses and has been the focus of many studies. [1][2][3][4][5][6] Results of these studies have been variable with regard to the optimal nebulizer location, but a general consensus in the literature has emerged suggesting placement of the nebulizer between the mask and leak port (ie, in a pre-mask position, as seen in Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

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Face Mask Leak Determines Aerosol Delivery in Noninvasive Ventilation

et al. 2020

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BACKGROUND: Aerosol transport during noninvasive ventilation follows the flow of pressurized gas through the noninvasive ventilation circuit, vented via leak port and face mask, and inhaled by the patient. Recommendations for nebulizer placement are based on in vitro models that have focused primarily on aerosol losses via the leak port; face mask leaks have been avoided. This study tested aerosol delivery in the setting of controlled face mask leak. METHODS: Three nebulizer technologies were studied on a bench model using a lung simulator with a face mask placed onto a manikin head. Radiolabeled aerosol delivery (ie, inhaled mass) was determined by mass balance using filters and a gamma camera that tested the effects of nebulizer location and face mask leak. Low (15-20 L/min) and high (55-60 L/min) mask leaks were used to mimic realistic clinical conditions. RESULTS: Inhaled mass (% nebulizer charge) was a function of nebulizer technology (with the nebulizer at ventilator outlet position: Aerogen 22.8%, InspiRx 11.1%, and Hudson 8.1%; P 5 .001). The location of the nebulizer before or after the leak port was not important (P 5 0.13 at low leak and P 5 0.38 at high leak). Aerosol delivery was minimal with high mask leak (inhaled mass 1.5-7.0%). Aerosol losses at the leak port at low mask leak were 28-36% versus 9-24% at high mask leak. Aerosol losses via the mask leak were 16-20% at low mask leak versus 46-72% at high mask leak. Furthermore, high face mask leak led to significant deposition on the mask and face (eg, up to 50% of the nebulizer charge with the Aerogen mask). CONCLUSIONS: During noninvasive ventilation, nebulizer placement at the ventilator outlet, which is a more practical position, is effective and minimizes deposition on face and mask. Aerosol therapy should be avoided when there is high face mask leak.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Face Mask Leak Determines Aerosol Delivery in Noninvasive Ventilation

et al. 2020

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“…We try to avoid interference of backup respiratory frequency. The S mode was often chosen as the only tested mode in previous papers [26, 27]. To the best of our knowledge, there is no study related to the comparison of the effect of different modes on nebulization during NPPV.…”

Section: Discussionmentioning

confidence: 99%

Effect of Jet Nebulization on Noninvasive Positive-Pressure Ventilation Administered with Noninvasive or Intensive Care Unit Ventilators: A Bench Study

Dai

Peng

et al. 2018

Respiration

Self Cite

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Background: Most of the patients on noninvasive positive pressure ventilation require aerosol inhalation therapy to moisturize the airways or deliver drugs in acute settings. However, the effect of jet nebulization on noninvasive positive pressure ventilation (NPPV) has not been determined. Objectives: This study was designed to investigate the impact of jet nebulization on NPPV applied in ventilators. Methods: Aerosol therapy during NPPV was conducted in a simulated lung. The jet nebulizer was connected at both the distal and proximal end of the exhalation valve for the noninvasive ventilators, while it was placed both in front of the Y tube proximal to the patient and at 15 cm distance from the Y-tube inspiratory limb distal to the patient for the intensive care unit (ICU) ventilators. Driving flow was set at 4 and 8 L/min, respectively. Results: TP_min (time from the beginning of the lung simulator’s inspiratory effort to the lowest value of airway pressure needed to trigger the ventilator), T_trig (time to trigger), and P_trig (the magnitude of airway pressure drop needed to trigger) were not significantly altered by jet nebulization in the noninvasive ventilators, while they were significantly increased in the ICU ventilators. The greater the driving flow, the stronger the impact on TP_min, T_trig, and P_trig. The actual tidal volume and control performance were not significantly affected by jet nebulization in either noninvasive or ICU ventilators. The tidal volume monitored was significantly increased at 8 L/min driving flow. The greater the driving flow, the stronger the impact on the tidal volume monitored. Conclusion: The effect of jet nebulization on NPPV was different when compared to invasive ventilation. Jet nebulization only affected the tidal volume monitored in the noninvasive ventilator. Jet nebulization also affected the triggering performance and tidal volume monitored in the ICU ventilator.

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“…The efficacy of aerosol therapy in patients undergoing NIV has been studied in terms of drug administration and also factors regarding the device (i.e., the position and type of nebulizers) 3 , 7 – 13 . Regarding the implications for the ventilator, it is known that the administration of external gas can influence the patient’s tidal volume and patient-ventilator synchronization 14 .…”

Section: Introductionmentioning

confidence: 99%

A bench-to-bedside study about trigger asynchronies induced by the introduction of external gas into the non-invasive mechanical ventilation circuit

Lalmolda

Flórez

Grimau³

et al. 2021

Sci Rep

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Treatments that require the introduction of external gas into the non-invasive ventilation (NIV) circuit, such as aerosol and oxygen therapy, may influence the performance of the ventilator trigger system. The aim of the study was to determine the presence and type of asynchronies induced by external gas in the NIV circuit in a bench model and in a group of patients undergoing chronic NIV. Bench study: Four ventilators (one with two different trigger design types) and three gas sources (continuous flow at 4 and 9 l/min and pulsatile flow at 9 l/min) were selected in an active simulator model. The sensitivity of the trigger, the gas introduction position, the ventilatory pattern and the level of effort were also modified. The same ventilators and gas conditions were used in patients undergoing chronic NIV. Bench: the introduction of external gas caused asynchronies in 35.9% of cases (autotriggering 73%, ineffective effort 27%). Significant differences (p < 0.01) were detected according to the ventilator model and the gas source. In seven patients, the introduction of external gas induced asynchrony in 20.4% of situations (77% autotriggering). As in the bench study, there were differences in the occurrence of asynchronies depending on the ventilator model and gas source used. The introduction of external gas produces alterations in the ventilator trigger. These alterations are variable, and depend on the ventilator design and gas source. This phenomenon makes it advisable to monitor the patient at the start of treatment.

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

Cited by 10 publications

References 21 publications

Face Mask Leak Determines Aerosol Delivery in Noninvasive Ventilation

Face Mask Leak Determines Aerosol Delivery in Noninvasive Ventilation

Effect of Jet Nebulization on Noninvasive Positive-Pressure Ventilation Administered with Noninvasive or Intensive Care Unit Ventilators: A Bench Study

A bench-to-bedside study about trigger asynchronies induced by the introduction of external gas into the non-invasive mechanical ventilation circuit

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