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Pillay K, Chen JZ, Finlay WH, Martin AR. Inhaled Nitric Oxide: In Vitro Analysis of Continuous Flow Noninvasive Delivery via Nasal Cannula. Respir Care 2021; 66:228-239. [PMID: 32843510 PMCID: PMC9994215 DOI: 10.4187/respcare.07737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Inhaled nitric oxide (NO) is most frequently delivered to mechanically ventilated patients in critical care, but it can also be administered noninvasively. The delivered dose and efficiency of continuous flow NO supplied through a nasal cannula has yet to be established. This study aimed to determine the influence of nasal cannula type, supply flow, and breathing pattern on delivered NO using a realistic adult airway replica and lung simulator. METHODS Simulated breathing patterns were selected to represent rest, sleep, and light exercise, and were varied to investigate the effects of tidal volume and breathing frequency independently. Supplied gas flows targeted tracheal concentrations at rest of 5 or 20 ppm NO and were supplied with 2 L/min O2. Three different cannulas were tested. Tracheal NO concentrations and NO mass flow past the trachea were evaluated. RESULTS Cannula type had a minor influence on delivered dose. Tracheal NO concentrations differed significantly based on breathing pattern (P < 0.01); for a target NO concentration of 20 ppm at rest, average inhaled NO concentrations were 23.3 ± 0.5 ppm, 36.5 ± 1.4 ppm, and 17.2 ± 0.3 ppm for the rest, sleep, and light exercise breathing patterns, respectively. For the same test conditions, mass flow of NO past the trachea was less sensitive to breathing pattern: 20.3 ± 0.5 mg/h, 19.9 ± 0.8 mg/h, and 24.3 ± 0.4 mg/h for the rest, sleep, and light exercise breathing patterns, respectively. Mass flow and delivery efficiency increased when minute volume increased. CONCLUSIONS These results indicate that inhaled NO concentration is strongly influenced by breathing pattern, whereas inhaled NO mass flow is not. NO mass flow may therefore be a useful dose metric for continuous flow delivery via nasal cannula.
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Affiliation(s)
- Kineshta Pillay
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - John Z Chen
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Warren H Finlay
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew R Martin
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada.
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Kolli AR, Kuczaj AK, Martin F, Hayes AW, Peitsch MC, Hoeng J. Bridging inhaled aerosol dosimetry to physiologically based pharmacokinetic modeling for toxicological assessment: nicotine delivery systems and beyond. Crit Rev Toxicol 2020; 49:725-741. [PMID: 31903848 DOI: 10.1080/10408444.2019.1692780] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
One of the challenges for toxicological assessment of inhaled aerosols is to accurately predict their deposited and absorbed dose. Transport, evolution, and deposition of liquid aerosols are driven by complex processes dominated by convection-diffusion that depend on various factors related to physics and chemistry. These factors include the physicochemical properties of the pure substance of interest and associated mixtures, the physical and chemical properties of the aerosols generated, the interplay between different factors during transportation and deposition, and the subject-specific inhalation topography. Several inhalation-based physiologically based pharmacokinetic (PBPK) models have been developed, but the applicability of these models for aerosols has yet to be verified. Nicotine is among several substances that are often delivered via the pulmonary route, with varied kinetics depending upon the route of exposure. This was used as an opportunity to review and discuss the current knowledge and state-of-the-art tools combining aerosol dosimetry predictions with PBPK modeling efforts. A validated tool could then be used to perform for toxicological assessment of other inhaled therapeutic substances. The Science Panel from the Alliance of Risk Assessment have convened at the "Beyond Science and Decisions: From Problem Formulation to Dose-Response Assessment" workshop to evaluate modeling approaches and address derivation of exposure-internal dose estimations for inhaled aerosols containing nicotine or other substances. The discussion involved PBPK model evaluation criteria, challenges, and choices that arise in such a model design, development, and application as a computational tool for use in human toxicological assessments.
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Affiliation(s)
- A R Kolli
- PMI R&D, Philip Morris Products S.A, Neuchâtel, Switzerland
| | - A K Kuczaj
- PMI R&D, Philip Morris Products S.A, Neuchâtel, Switzerland.,Department of Applied Mathematics, Faculty EEMCS, University of Twente, Enschede, The Netherlands
| | - F Martin
- PMI R&D, Philip Morris Products S.A, Neuchâtel, Switzerland
| | - A W Hayes
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - M C Peitsch
- PMI R&D, Philip Morris Products S.A, Neuchâtel, Switzerland
| | - J Hoeng
- PMI R&D, Philip Morris Products S.A, Neuchâtel, Switzerland
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Zapol WM, Charles HC, Martin AR, Sá RC, Yu B, Ichinose F, MacIntyre N, Mammarappallil J, Moon R, Chen JZ, Geier ET, Darquenne C, Prisk GK, Katz I. Pulmonary Delivery of Therapeutic and Diagnostic Gases. J Aerosol Med Pulm Drug Deliv 2018; 31:78-87. [PMID: 29451844 DOI: 10.1089/jamp.2017.1431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The 21st Congress for the International Society for Aerosols in Medicine included, for the first time, a session on Pulmonary Delivery of Therapeutic and Diagnostic Gases. The rationale for such a session within ISAM is that the pulmonary delivery of gaseous drugs in many cases targets the same therapeutic areas as aerosol drug delivery, and is in many scientific and technical aspects similar to aerosol drug delivery. This article serves as a report on the recent ISAM congress session providing a synopsis of each of the presentations. The topics covered are the conception, testing, and development of the use of nitric oxide to treat pulmonary hypertension; the use of realistic adult nasal replicas to evaluate the performance of pulsed oxygen delivery devices; an overview of several diagnostic gas modalities; and the use of inhaled oxygen as a proton magnetic resonance imaging (MRI) contrast agent for imaging temporal changes in the distribution of specific ventilation during recovery from bronchoconstriction. Themes common to these diverse applications of inhaled gases in medicine are discussed, along with future perspectives on development of therapeutic and diagnostic gases.
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Affiliation(s)
- Warren M Zapol
- 1 Anesthesia Center for Critical Care Research , Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - H Cecil Charles
- 2 Duke Image Analysis Laboratory, Center for Advanced MR Development, Department of Radiology, Duke University School of Medicine , Durham, North Carolina
| | - Andrew R Martin
- 3 Department of Mechanical Engineering, University of Alberta , Edmonton, Canada
| | - Rui C Sá
- 4 Department of Medicine, University of California , San Diego, San Diego, California
| | - Binglan Yu
- 1 Anesthesia Center for Critical Care Research , Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Fumito Ichinose
- 1 Anesthesia Center for Critical Care Research , Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neil MacIntyre
- 5 Department of Pulmonology, Duke University School of Medicine , Durham, North Carolina
| | - Joseph Mammarappallil
- 6 Department of Radiology, Duke University School of Medicine , Durham, North Carolina
| | - Richard Moon
- 7 Department of Anesthesiology, Duke University School of Medicine , Durham, North Carolina
| | - John Z Chen
- 3 Department of Mechanical Engineering, University of Alberta , Edmonton, Canada
| | - Eric T Geier
- 4 Department of Medicine, University of California , San Diego, San Diego, California
| | - Chantal Darquenne
- 4 Department of Medicine, University of California , San Diego, San Diego, California
| | - G Kim Prisk
- 4 Department of Medicine, University of California , San Diego, San Diego, California.,8 Department of Radiology, University of California , San Diego, San Diego, California
| | - Ira Katz
- 9 Medical R&D, Air Liquide Santé International , Les Loges-en-Josas, France .,10 Department of Mechanical Engineering, Lafayette College , Easton, Pennsylvania
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4
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Katz I, Murdock J, Palgen M, Pype J, Caillibotte G. Pharmacokinetic analysis of the chronic administration of the inert gases Xe and Ar using a physiological based model. Med Gas Res 2015; 5:8. [PMID: 26113973 PMCID: PMC4480577 DOI: 10.1186/s13618-015-0029-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background New gas therapies using inert gases such as xenon and argon are being studied, which would require chronically administered repeating doses. The pharmacokinetics of this type of administration has not been addressed in the literature. Methods A physiologically based pharmacokinetics (PBPK) model for humans, pigs, mice, and rats has been developed to investigate the unique aspects of the chronic administration of inert gas therapies. The absorption, distribution, metabolism and excretion (ADME) models are as follows: absorption in all compartments is assumed to be perfusion limited, no metabolism of the gases occurs, and excretion is only the reverse process of absorption through the lungs and exhaled. Results The model has shown that there can be a residual dose, equivalent to constant administration, for chronic repeated dosing of xenon in humans. However, this is not necessarily the case for small animals used in pre-clinical studies. Conclusions The use of standard pharmacokinetics parameters such as area under the curve would be more appropriate to assess the delivered dose of chronic gas administration than the gas concentration in the delivery system that is typically reported in the scientific literature because species and gas differences can result in very different delivered doses.
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Affiliation(s)
- Ira Katz
- Medical R&D, Air Liquide Santé International, Centre de Recherche Paris-Saclay, 1, chemin de la Porte des Loges, BP126 - 78354 Jouy en Josas, France ; Department of Mechanical Engineering, Lafayette College, Easton, PA 18042 USA
| | - Jacqueline Murdock
- Medical R&D, Air Liquide Santé International, Centre de Recherche Paris-Saclay, 1, chemin de la Porte des Loges, BP126 - 78354 Jouy en Josas, France
| | - Marc Palgen
- Medical R&D, Air Liquide Santé International, Centre de Recherche Paris-Saclay, 1, chemin de la Porte des Loges, BP126 - 78354 Jouy en Josas, France
| | - Jan Pype
- Medical R&D, Air Liquide Santé International, Centre de Recherche Paris-Saclay, 1, chemin de la Porte des Loges, BP126 - 78354 Jouy en Josas, France
| | - Georges Caillibotte
- Medical R&D, Air Liquide Santé International, Centre de Recherche Paris-Saclay, 1, chemin de la Porte des Loges, BP126 - 78354 Jouy en Josas, France
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