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Jacquier S, Lin HL, Li J, Sheridan CA, Karabelas P, Liu JF, Ehrmann S, Fink JB. Effect of Interrupting Heated Humidification on Nebulized Drug Delivery Efficiency, Temperature, and Absolute Humidity During Mechanical Ventilation: A Multi-Lab In Vitro Study. J Aerosol Med Pulm Drug Deliv 2024; 37:115-124. [PMID: 38563793 DOI: 10.1089/jamp.2023.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Introduction: During mechanical ventilation (MV), inspired gases require heat and humidification. However, such conditions may be associated with reduced aerosol delivery efficiency. The practice of turning off heated humidification before nebulization and the impact of nebulization on humidity in a dry ventilator circuit remain topics of debate. This study aimed to assess the effect of turning off heated humidification on inhaled dose and humidity with nebulizer use during adult MV. Methods: A bronchodilator (albuterol) and two antibiotics (Colistimethate sodium and Amikacin sulfate) were nebulized with a vibrating mesh nebulizer placed at the humidifier inlet and in the inspiratory limb at the Y-piece. Additionally, albuterol was nebulized using a jet nebulizer in both placements. Aerosol particle size distribution was determined through a cascade impactor. Absolute humidity (AH) and temperature of inspired gases were determined with anemometer/hygrometers before, during, and after nebulization, before, during, and up to 60 minutes after interrupting active humidification. Aerosol collected on a filter distal to the endotracheal tube and on impactor stages were eluted and assayed by spectrophotometry. Results: The inhaled dose was greater when both nebulizers were placed at the humidifier inlet than the inspiratory limb at the Y-piece. Irrespective of the nebulizer types and placements, the inhaled dose either decreased or showed no significant change after the humidifier was turned off. The aerosol particle size ranged from 1.1 to 2.7 μm. With interruption of active humidification, humidity of inspired gas quickly dropped below recommended levels, and nebulization in dry ventilator circuit produced an AH between 10 and 20 mgH2O/L, lower than the recommended minimum of 30 mgH2O/L. Conclusion: Interrupting active humidification during MV before nebulization did not improve aerosol delivery efficiency for bronchodilator or antibiotics, but did reduce humidity below recommended levels.
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Affiliation(s)
- Sophie Jacquier
- CHRU Tours, Médecine Intensive Réanimation, INSERM CIC 1415, CRICS-TriggerSep F-CRIN Research Network, Tours, France
- INSERM, Centre D'étude des Pathologies Respiratoires, Université de Tours, Tours, France
| | - Hui-Ling Lin
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Jie Li
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois, USA
- Aerogen Pharma Corp., San Mateo, California, USA
| | - Caylie A Sheridan
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois, USA
- Aerogen Pharma Corp., San Mateo, California, USA
| | - Paul Karabelas
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois, USA
- Aerogen Pharma Corp., San Mateo, California, USA
| | - Jui-Fang Liu
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Stephan Ehrmann
- CHRU Tours, Médecine Intensive Réanimation, INSERM CIC 1415, CRICS-TriggerSep F-CRIN Research Network, Tours, France
- INSERM, Centre D'étude des Pathologies Respiratoires, Université de Tours, Tours, France
| | - James B Fink
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois, USA
- Aerogen Pharma Corp., San Mateo, California, USA
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Lin HL, Fink JB, Li J. The Effects of Inspiratory Flows, Inspiratory Pause, and Suction Catheter on Aerosol Drug Delivery with Vibrating Mesh Nebulizers During Mechanical Ventilation. J Aerosol Med Pulm Drug Deliv 2024; 37:125-131. [PMID: 38563958 DOI: 10.1089/jamp.2023.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background: Some experts recommend specific ventilator settings during nebulization for mechanically ventilated patients, such as inspiratory pause, high inspiratory to expiratory ratio, and so on. However, it is unclear whether those settings improve aerosol delivery. Thus, we aimed to evaluate the impact of ventilator settings on aerosol delivery during mechanical ventilation (MV). Methods: Salbutamol (5.0 mg/2.5 mL) was nebulized by a vibrating mesh nebulizer (VMN) in an adult MV model. VMN was placed at the inlet of humidifier and 15 cm away from the Y-piece of the inspiratory limb. Eight scenarios with different ventilator settings were compared with endotracheal tube (ETT) connecting 15 cm from the Y-piece, including tidal volumes of 6-8 mL/kg, respiratory rates of 12-20 breaths/min, inspiratory time of 1.0-2.5 seconds, inspiratory pause of 0-0.3 seconds, and bias flow of 3.5 L/min. In-line suction catheter was utilized in two scenarios. Delivered drug distal to the ETT was collected by a filter, and drug was assayed by an ultraviolet spectrophotometry (276 nm). Results: Compared to the use of inspiratory pause, the inhaled dose without inspiratory pause was either higher or similar across all ventilation settings. Inhaled dose was negatively correlated with inspiratory flow with VMN placed at 15 cm away from the Y-piece (rs = -0.68, p < 0.001) and at the inlet of humidifier (rs = -0.83, p < 0.001). The utilization of in-line suction catheter reduced inhaled dose, regardless of the ventilator settings and nebulizer placements. Conclusions: When VMN was placed at the inlet of humidifier, directly connecting the Y-piece to ETT without a suction catheter improved aerosol delivery. In this configuration, the inhaled dose increased as the inspiratory flow decreased, inspiratory pause had either no or a negative impact on aerosol delivery. The inhaled dose was greater with VMN placed at the inlet of humidifier than 15 cm away the Y-piece.
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Affiliation(s)
- Hui-Ling Lin
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - James B Fink
- Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois, USA
- Aerogen Pharma Corp, San Mateo, California, USA
| | - Jie Li
- Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois, USA
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Fink JB. Reliability of Mesh Aerosol Devices Used During INHALE Trial. J Aerosol Med Pulm Drug Deliv 2022; 35:107-108. [PMID: 35166598 DOI: 10.1089/jamp.2022.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- James B Fink
- Allied Health Graduate Program, Rush University, Chicago, Illinois, USA
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Mac Giolla Eain M, O'Sullivan A, Joyce M, MacLoughlin R. In vitro evaluation of disposable transport ventilators with combination aerosol therapy. BMJ Open Respir Res 2021; 8:8/1/e000739. [PMID: 33771812 PMCID: PMC8006849 DOI: 10.1136/bmjresp-2020-000739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/30/2020] [Accepted: 03/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background The COVID-19 pandemic has highlighted the need for alternative short-term, reliable means to aid in the treatment of patients requiring ventilatory support. Concurrent aerosol drug delivery is often prescribed to such patients. As such, this study examines one such short-term option, the disposable gas-powered transport ventilator to effectively deliver aerosol therapy. Factors such as aerosol generator type, patient breathing pattern, humidification and nebuliser position within the respiratory circuit were also examined. Methods Aerosol drug delivery characterisation was undertaken using two different disposable transport ventilators (DTVs). Two different nebuliser types, a closed circuit vibrating mesh nebuliser (VMN) and an open circuit jet nebuliser (JN), at different locations in a respiratory circuit, proximal and distal to an endotracheal tube (ETT), with and without passive humidification, were evaluated in simulated adult and paediatric patients. Results Placement of a nebuliser proximal to the ETT (VMN: 25.19%–34.15% and JN: 3.14%–8.92%), and the addition of a heat and moisture exchange filter (VMN: 32.37%–40.43% and JN: 5.60%–9.91%) resulted in the largest potential lung dose in the adult patient model. Irrespective of nebuliser position and humidification in the respiratory circuit, use of the VMN resulted in the largest potential lung dose (%). A similar trend was recorded in the paediatric model data, where the largest potential lung dose was recorded with both nebuliser types placed proximal to the ETT (VMN: 8.12%–10.89% and JN: 2.15%–3.82%). However, the addition of a heat and moisture exchange filter had no statistically significant effect on the potential lung dose (%) a paediatric patient would receive (p>>0.05). Conclusions This study demonstrates that transport ventilators, such as DTVs, can be used concurrently with aerosol generators to effectively deliver aerosolised medication in both adult and paediatric patients.
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Affiliation(s)
| | | | - Mary Joyce
- R&D Science and Emerging Technologies, Aerogen Ltd, Galway, Ireland
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Ge HQ, Wang JM, Lin HL, Fink JB, Luo R, Xu P, Ying K. Effect of Nebulizer Location and Spontaneous Breathing on Aerosol Delivery During Airway Pressure Release Ventilation in Bench Testing. J Aerosol Med Pulm Drug Deliv 2018; 32:34-39. [PMID: 30199313 DOI: 10.1089/jamp.2018.1457] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Airway pressure release ventilation (APRV) maintains a sustained airway pressure over a large proportion of the respiratory cycle, and has a long inspiratory time at high pressure. The purpose of this study was to determine the influence of the APRV with and without spontaneous breathing on albuterol aerosol delivery with a continuous vibrating-mesh nebulizer (VMN) placed at different positions on an adult lung model of invasive mechanical ventilation. METHODS An adult lung model was assembled by connecting a ventilator with a dual-limb circuit to an 8-mm inner diameter endotracheal tube (ETT) and collecting filter attached to a test lung with set compliance of 0.1 L/cmH2O and resistance of 0.5 cmH2O/(L·s). Four ventilator modes were compared: pressure control ventilation (PCV) with no bias flow, PCV with bias flow of 6 L/min (PCVBF6), APRV with no spontaneous breaths (APRV), and APRV with spontaneous breath trigger (APRVs). Peak inspiratory pressure, peak end-expiratory pressure, aerosol dose, and nebulization time were similar for all modes. The VMN was placed (1) between Y-piece and inspiratory limb, (2) at the gas outlet of a heated humidifier, and (3) at the gas inlet of a heated humidifier. Albuterol sulfate (5 mg/2.5 mL) was administered with each run and collected on a filter distal to the ETT. Deposited drug was eluted from each filter (purified water) and analyzed by UV spectrophotometry at 276 nm. Analysis of variance [general linear model (GLM) multivariate] was performed using the linear model of multiple variables, significance at p < 0.05. RESULTS Albuterol (in micrograms, mean ± standard deviation) delivered was higher with VMN placed at the gas inlet of the humidifier with each mode of ventilation (p < 0.01). APRVs has the highest albuterol delivery followed by PCV, PCVBF6, and APRV (1706.2 ± 60.9 μg vs. 1490.6 ± 61.1 μg vs. 1182.3 ± 61.4 μg vs. 1153.1 ± 99.7 μg, respectively, p < 0.001). The minute volume was positively correlated with the inhaled albuterol dose. CONCLUSIONS Spontaneous breathing increased the albuterol delivery during APRV, compared with APRV alone and PCV modes. Placing the nebulizer proximal to the ventilator was more efficient for all modes tested.
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Affiliation(s)
- Hui-Qing Ge
- 1 Department of Respiratory Care, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ji-Mei Wang
- 1 Department of Respiratory Care, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hui-Ling Lin
- 2 Department of Respiratory Care, Chang Gung University, Taoyuan City, Taiwan
| | | | - Ronghua Luo
- 4 Department of Cardiology, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Peifeng Xu
- 1 Department of Respiratory Care, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kejing Ying
- 5 Department of Pulmonary Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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