1
|
Brokken T, Hütten MC, Ophelders DRMG, van Gorp C, Wolfs TGAM, Wald M. Optimized lung expansion ventilation modulates ventilation-induced lung injury in preterm lambs. Pediatr Pulmonol 2024. [PMID: 38958257 DOI: 10.1002/ppul.27153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 06/03/2024] [Accepted: 06/14/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION Preterm infants close to viability commonly require mechanical ventilation (MV) for respiratory distress syndrome. Despite commonly used lung-sparing ventilation techniques, rapid lung expansion during MV induces lung injury, a risk factor for bronchopulmonary dysplasia. This study investigates whether ventilation with optimized lung expansion is feasible and whether it can further minimize lung injury. Therefore, optimized lung expansion ventilation (OLEV) was compared to conventional volume targeted ventilation. METHODS Twenty preterm lambs were surgically delivered after 132 days of gestation. Nine animals were randomized to receive OLEV for 24 h, and seven received standard MV. Four unventilated animals served as controls (NV). Lungs were sampled for histological analysis at the end of the experimental period. RESULTS Ventilation with OLEV was feasible, resulting in a significantly higher mean ventilation pressure (0.7-1.3 mbar). Temporary differences in oxygenation between OLEV and MV did not reach clinically relevant levels. Ventilation in general tended to result in higher lung injury scores compared to NV, without differences between OLEV and MV. While pro-inflammatory tumor necrosis factor-α messenger RNA (mRNA) levels increased in both ventilation groups compared to NV, only animals in the MV group showed a higher number of CD45-positive cells in the lung. In contrast, mean (standard deviations) surfactant protein-B mRNA levels were significantly lower in OLEV, 0.63 (0.38) compared to NV 1.03 (0.32) (p = .023, one-way analysis of variance). CONCLUSION In conclusion, a small reduction in pulmonary inflammation after 24 h of support with OLEV suggests potential to reduce preterm lung injury.
Collapse
Affiliation(s)
- Tim Brokken
- Divisions of Neonatology, MosaKids Children's Hospital, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Matthias C Hütten
- Divisions of Neonatology, MosaKids Children's Hospital, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Daan R M G Ophelders
- Divisions of Neonatology, MosaKids Children's Hospital, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Charlotte van Gorp
- Divisions of Neonatology, MosaKids Children's Hospital, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Tim G A M Wolfs
- Divisions of Neonatology, MosaKids Children's Hospital, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Martin Wald
- Divisions of Neonatology, Department of Pediatrics and Adolescent Medicine, Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
2
|
He Y, Liu Y, Zhang Z, Liu H, Hu D, Feng S, Li R, Wang Y, Ma W. Impact of airway devices and emergency airway techniques characteristics on airway adverse events in mainland China: a cross-sectional study. Minerva Anestesiol 2024; 90:607-617. [PMID: 39021136 DOI: 10.23736/s0375-9393.24.18035-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
BACKGROUND Novel airway devices are becoming widely available, yet it is unclear whether the techniques or preferences of airway practitioners for airway management have been impacted. Given these facts, a cross-sectional study of the current status of airway management in mainland China was conducted and compared with previous survey findings. METHODS The national survey was conducted from November 7th to November 28th, 2022. An electronic survey was sent to the New Youth Anesthesia Forum to examine the availability of airway devices, preference for front-of-neck access (FONA) techniques, the incidence of adverse airway events, and the status of airway management training. RESULTS Questionnaires were completed by 3783 respondents, with a response rate of 72.14%. So far, the availability of optical airway devices has improved dramatically, with the availability of videolaryngoscopes reaching 97.18%. When encountering "cannot intubate, cannot ventilate" (CICV) scenarios, the majority of respondents would prefer needle cricothyrotomy to establish FONA. However, less than a quarter of respondents had actually performed it. Moreover, the incidence of airway adverse events from 2016 to 2022 was 11.48%, of which 5.13% were brain damage or death. Multivariate logistic regression analysis revealed that the ability to perform FONA techniques (odds ratio [OR] 0.23, 95% CI: 0.16, 0.32; P<0.001) and the availability of difficult airway management carts or kits (OR 0.59, 95% CI 0.41, 0.85; P=0.005) were associated with a lower incidence of airway adverse events. CONCLUSIONS Optical airway devices can overcome some of the challenges posed by difficult airways, yet the CICV scenario remains a major obstacle. The future focus of airway management should be training, particularly for complicated emergency airway techniques.
Collapse
Affiliation(s)
- Yuewen He
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yurui Liu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhengze Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hao Liu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Die Hu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Siqi Feng
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ruogen Li
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yong Wang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wuhua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China -
| |
Collapse
|
3
|
Nof E, Bhardwaj S, Koullapis P, Bessler R, Kassinos S, Sznitman J. In vitro-in silico correlation of three-dimensional turbulent flows in an idealized mouth-throat model. PLoS Comput Biol 2023; 19:e1010537. [PMID: 36952557 PMCID: PMC10072468 DOI: 10.1371/journal.pcbi.1010537] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 04/04/2023] [Accepted: 02/08/2023] [Indexed: 03/25/2023] Open
Abstract
There exists an ongoing need to improve the validity and accuracy of computational fluid dynamics (CFD) simulations of turbulent airflows in the extra-thoracic and upper airways. Yet, a knowledge gap remains in providing experimentally-resolved 3D flow benchmarks with sufficient data density and completeness for useful comparison with widely-employed numerical schemes. Motivated by such shortcomings, the present work details to the best of our knowledge the first attempt to deliver in vitro-in silico correlations of 3D respiratory airflows in a generalized mouth-throat model and thereby assess the performance of Large Eddy Simulations (LES) and Reynolds-Averaged Numerical Simulations (RANS). Numerical predictions are compared against 3D volumetric flow measurements using Tomographic Particle Image Velocimetry (TPIV) at three steady inhalation flowrates varying from shallow to deep inhalation conditions. We find that a RANS k-ω SST model adequately predicts velocity flow patterns for Reynolds numbers spanning 1'500 to 7'000, supporting results in close proximity to a more computationally-expensive LES model. Yet, RANS significantly underestimates turbulent kinetic energy (TKE), thus underlining the advantages of LES as a higher-order turbulence modeling scheme. In an effort to bridge future endevours across respiratory research disciplines, we provide end users with the present in vitro-in silico correlation data for improved predictive CFD models towards inhalation therapy and therapeutic or toxic dosimetry endpoints.
Collapse
Affiliation(s)
- Eliram Nof
- Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| | - Saurabh Bhardwaj
- Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| | - Pantelis Koullapis
- Computational Sciences Laboratory (UCY-CompSci), Department of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia, Cyprus
| | - Ron Bessler
- Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| | - Stavros Kassinos
- Computational Sciences Laboratory (UCY-CompSci), Department of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia, Cyprus
| | - Josué Sznitman
- Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
4
|
Nof E, Zidan H, Artzy-Schnirman A, Mouhadeb O, Beckerman M, Bhardwaj S, Elias-Kirma S, Gur D, Beth-Din A, Levenberg S, Korin N, Ordentlich A, Sznitman J. Human Multi-Compartment Airways-on-Chip Platform for Emulating Respiratory Airborne Transmission: From Nose to Pulmonary Acini. Front Physiol 2022; 13:853317. [PMID: 35350687 PMCID: PMC8957966 DOI: 10.3389/fphys.2022.853317] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/15/2022] [Indexed: 12/15/2022] Open
Abstract
The past decade has witnessed tremendous endeavors to deliver novel preclinical in vitro lung models for pulmonary research endpoints, including foremost with the advent of organ- and lung-on-chips. With growing interest in aerosol transmission and infection of respiratory viruses within a host, most notably the SARS-CoV-2 virus amidst the global COVID-19 pandemic, the importance of crosstalk between the different lung regions (i.e., extra-thoracic, conductive and respiratory), with distinct cellular makeups and physiology, are acknowledged to play an important role in the progression of the disease from the initial onset of infection. In the present Methods article, we designed and fabricated to the best of our knowledge the first multi-compartment human airway-on-chip platform to serve as a preclinical in vitro benchmark underlining regional lung crosstalk for viral infection pathways. Combining microfabrication and 3D printing techniques, our platform mimics key elements of the respiratory system spanning (i) nasal passages that serve as the alleged origin of infections, (ii) the mid-bronchial airway region and (iii) the deep acinar region, distinct with alveolated airways. Crosstalk between the three components was exemplified in various assays. First, viral-load (including SARS-CoV-2) injected into the apical partition of the nasal compartment was detected in distal bronchial and acinar components upon applying physiological airflow across the connected compartment models. Secondly, nebulized viral-like dsRNA, poly I:C aerosols were administered to the nasal apical compartment, transmitted to downstream compartments via respiratory airflows and leading to an elevation in inflammatory cytokine levels secreted by distinct epithelial cells in each respective compartment. Overall, our assays establish an in vitro methodology that supports the hypothesis for viral-laden airflow mediated transmission through the respiratory system cellular landscape. With a keen eye for broader end user applications, we share detailed methodologies for fabricating, assembling, calibrating, and using our multi-compartment platform, including open-source fabrication files. Our platform serves as an early proof-of-concept that can be readily designed and adapted to specific preclinical pulmonary research endpoints.
Collapse
Affiliation(s)
- Eliram Nof
- Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hikaia Zidan
- Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| | - Arbel Artzy-Schnirman
- Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| | - Odelia Mouhadeb
- Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel.,Israel Institute for Biological Research, Ness Ziona, Israel
| | - Margarita Beckerman
- Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| | - Saurabh Bhardwaj
- Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shani Elias-Kirma
- Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| | - Didi Gur
- Israel Institute for Biological Research, Ness Ziona, Israel
| | - Adi Beth-Din
- Israel Institute for Biological Research, Ness Ziona, Israel
| | - Shulamit Levenberg
- Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| | - Netanel Korin
- Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| | - Arie Ordentlich
- Israel Institute for Biological Research, Ness Ziona, Israel
| | - Josué Sznitman
- Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
5
|
Sznitman J. Revisiting Airflow and Aerosol Transport Phenomena in the Deep Lungs with Microfluidics. Chem Rev 2021; 122:7182-7204. [PMID: 34964615 DOI: 10.1021/acs.chemrev.1c00621] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The dynamics of respiratory airflows and the associated transport mechanisms of inhaled aerosols characteristic of the deep regions of the lungs are of broad interest in assessing both respiratory health risks and inhalation therapy outcomes. In the present review, we present a comprehensive discussion of our current understanding of airflow and aerosol transport phenomena that take place within the unique and complex anatomical environment of the deep lungs, characterized by submillimeter 3D alveolated airspaces and nominally slow resident airflows, known as low-Reynolds-number flows. We exemplify the advances brought forward by experimental efforts, in conjunction with numerical simulations, to revisit past mechanistic theories of respiratory airflow and particle transport in the distal acinar regions. Most significantly, we highlight how microfluidic-based platforms spanning the past decade have accelerated opportunities to deliver anatomically inspired in vitro solutions that capture with sufficient realism and accuracy the leading mechanisms governing both respiratory airflow and aerosol transport at true scale. Despite ongoing challenges and limitations with microfabrication techniques, the efforts witnessed in recent years have provided previously unattainable in vitro quantifications on the local transport properties in the deep pulmonary acinar airways. These may ultimately provide new opportunities to explore improved strategies of inhaled drug delivery to the deep acinar regions by investigating further the mechanistic interactions between airborne particulate carriers and respiratory airflows at the pulmonary microscales.
Collapse
Affiliation(s)
- Josué Sznitman
- Department of Biomedical Engineering, Technion - Israel Institute of Technology, Haifa 32000, Israel
| |
Collapse
|
6
|
Nof E, Artzy‐Schnirman A, Bhardwaj S, Sabatan H, Waisman D, Hochwald O, Gruber M, Borenstein‐Levin L, Sznitman J. Ventilation‐induced epithelial injury drives biological onset of lung trauma in vitro and is mitigated with prophylactic anti‐inflammatory therapeutics. Bioeng Transl Med 2021; 7:e10271. [PMID: 35600654 PMCID: PMC9115701 DOI: 10.1002/btm2.10271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 01/25/2023] Open
Abstract
Mortality rates among patients suffering from acute respiratory failure remain perplexingly high despite the maintenance of blood oxygen homeostasis during ventilatory support. The biotrauma hypothesis advocates that mechanical forces from invasive ventilation trigger immunological mediators that spread systemically. Yet, how these forces elicit an immune response remains unclear. Here, a biomimetic in vitro three‐dimensional (3D) upper airways model allows to recapitulate lung injury and immune responses induced during invasive mechanical ventilation in neonates. Under such ventilatory support, flow‐induced stresses injure the bronchial epithelium of the intubated airways model and directly modulate epithelial cell inflammatory cytokine secretion associated with pulmonary injury. Fluorescence microscopy and biochemical analyses reveal site‐specific susceptibility to epithelial erosion in airways from jet‐flow impaction and are linked to increases in cell apoptosis and modulated secretions of cytokines IL‐6, ‐8, and ‐10. In an effort to mitigate the onset of biotrauma, prophylactic pharmacological treatment with Montelukast, a leukotriene receptor antagonist, reduces apoptosis and pro‐inflammatory signaling during invasive ventilation of the in vitro model. This 3D airway platform points to a previously overlooked origin of lung injury and showcases translational opportunities in preclinical pulmonary research toward protective therapies and improved protocols for patient care.
Collapse
Affiliation(s)
- Eliram Nof
- Faculty of Biomedical Engineering Technion ‐ Israel Institute of Technology Haifa Israel
| | - Arbel Artzy‐Schnirman
- Faculty of Biomedical Engineering Technion ‐ Israel Institute of Technology Haifa Israel
| | - Saurabh Bhardwaj
- Faculty of Biomedical Engineering Technion ‐ Israel Institute of Technology Haifa Israel
| | - Hadas Sabatan
- Faculty of Biomedical Engineering Technion ‐ Israel Institute of Technology Haifa Israel
| | - Dan Waisman
- Faculty of Medicine Technion ‐ Israel Institute of Technology Haifa Israel
- Department of Neonatology Carmel Medical Center Haifa Israel
| | - Ori Hochwald
- Faculty of Medicine Technion ‐ Israel Institute of Technology Haifa Israel
- Department of Neonatology Ruth Rappaport Children's Hospital, Rambam Healthcare Haifa Israel
| | - Maayan Gruber
- Azrieli Faculty of Medicine Bar‐Ilan University Safed Israel
- Department of Otolaryngology‐Head and Neck Surgery Galilee Medical Center Nahariya Israel
| | - Liron Borenstein‐Levin
- Faculty of Medicine Technion ‐ Israel Institute of Technology Haifa Israel
- Department of Neonatology Ruth Rappaport Children's Hospital, Rambam Healthcare Haifa Israel
| | - Josué Sznitman
- Faculty of Biomedical Engineering Technion ‐ Israel Institute of Technology Haifa Israel
| |
Collapse
|
7
|
Gil A, Martínez M, Quintero P, Medina A. Computational evaluation of rebreathing and effective dead space on a helmet-like interface during the COVID-19 pandemic. J Biomech 2021; 118:110302. [PMID: 33578054 PMCID: PMC7857993 DOI: 10.1016/j.jbiomech.2021.110302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/07/2020] [Accepted: 01/23/2021] [Indexed: 01/10/2023]
Abstract
The coronavirus disease 2019 (COVID-19) is a potentially severe acute respiratory infection caused by severe acute respiratory syndrome coronavirus 2. The potential for transmission of this disease has led to an important scarcity of health-care resources. Consequently, alternative solutions have been explored by many physicians and researchers. Non-invasive Ventilation has been revealed as one alternative for patients with associated acute respiratory distress syndrome. This technique is being used in combination with helmet-like interfaces because of their versatility and affordability. However, these interfaces could experience important problems of CO2 rebreathing, especially under low flow rate conditions. This work proposes a Computational Fluid Dynamics method to accurately characterize the fluid flow in a pre-design environment of helmet-like interfaces. Parameters as effective dead space, rebreathing, pressure, or temperature field distribution are quantified and analysed in detail in order to study the performance and feasibility of such devices to relieve the effects of respiratory infections.
Collapse
Affiliation(s)
- A Gil
- CMT-Motores Térmicos, Universitat Politècnica de Valpencia, Camino de Vera, s/n, Valencia 46022, Spain
| | - M Martínez
- Hospital General Universitari de Castelló, Avinguda de Benicàssim, 128, 12004 Castellón de la Plana, Castellón, Spain
| | - P Quintero
- CMT-Motores Térmicos, Universitat Politècnica de Valpencia, Camino de Vera, s/n, Valencia 46022, Spain.
| | - A Medina
- Hospital Universitario Central de Asturias, Avenida de Roma, s/n, 33011 Oviedo, Asturias, Spain
| |
Collapse
|
8
|
Bach KP, Kuschel CA, Patterson N, Skwish H, Huth S, Phua HH, Bloomfield FH. Effect of Bias Gas Flow on Tracheal Cytokine Concentrations in Ventilated Extremely Preterm Infants: A Randomized Controlled Trial. Neonatology 2021; 118:332-339. [PMID: 33827091 PMCID: PMC8491472 DOI: 10.1159/000515364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/12/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The objective of this study was to determine whether ventilator bias gas flow affects tracheal aspirate (TA) cytokine concentrations in ventilated extremely preterm infants. METHODS This is a randomized controlled trial in a tertiary neonatal unit in New Zealand. Preterm infants (<28 weeks' gestation/<1,000 g) requiring intubation in the first 7 days after birth were randomized to bias gas flows of 4 or 10 L/min. Cytokine concentrations in TA and plasma were measured at 24, 72, and 120 h after the onset of ventilation. The primary outcome measure was concentration of interleukin (IL)-8 in TA 24 h after the onset of mechanical ventilation. RESULTS Baseline demographics were similar in babies randomized to 4 (n = 50) and 10 (n = 45) L/min bias gas flow. TA IL-8 concentrations were not different between groups. Plasma IL-8 concentrations decreased over time (p < 0.05). Respiratory support and incidence of bronchopulmonary dysplasia at 36 weeks' corrected gestational age were similar between groups. Fewer babies ventilated at 4 L/min developed necrotizing enterocolitis (NEC) ≥ stage 2 (n = 0 vs. n = 5; p = 0.02) and fewer died (n = 1 vs. n = 5, p = 0.06). CONCLUSIONS Lower bias gas flow in ventilated extremely preterm infants did not alter TA cytokine concentrations but the lower incidence of NEC and mortality warrants further investigation.
Collapse
Affiliation(s)
- Katinka P Bach
- Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | | | - Nicola Patterson
- Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Hana Skwish
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA
| | - Sabine Huth
- Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Hui Hui Phua
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | |
Collapse
|
9
|
In silico optimization of targeted aerosol delivery in upper airways via Inhaled Volume Tracking. Clin Biomech (Bristol, Avon) 2020; 80:105138. [PMID: 32798812 PMCID: PMC7611794 DOI: 10.1016/j.clinbiomech.2020.105138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the widespread use of aerosol inhalation as a drug delivery method, targeted delivery to the upper airways remains an ongoing challenge in the quest for improved clinical response in respiratory disease. METHODS Here, we examine in silico flow and particle dynamics when using an oral Inhaled Volume Tracking manoeuvre. A short pulsed aerosol bolus is injected during slow inhalation flow rates followed by clean air, and a breath-hold is initiated once it reaches the desired depth. We explore the fate of a broad particle size range (1-40 μm) for both upright and supine positions. FINDINGS Our findings illustrate that despite attempts to mitigate dispersion using slower flow rates, the laryngeal jet disperses the aerosol bolus and thus remains a hurdle for efficient targeted delivery. Nevertheless, we show a decrease in extra-thoracic deposition; large aerosols in the range of 10-30 μm potentially outperform existing inhalation methods, showing deposition fractions of up to 80% in an upright orientation. INTERPRETATION The improved deposition during Inhaled Volume Tracking shows promise for clinical applications and could be leveraged to deliver larger payloads to the upper airways.
Collapse
|