A homemade modification of a spacer device for delivery of bronchodilator or steroid therapy in patients with tracheostomies

Abstract

Patients who have artificial airways and who concurrently suffer with chronic obstructive airways disease encounter problems when administering inhaled bronchodilator and corticosteroid drugs via the tracheostomy. This is because most of the devices are designed to deliver the metered dose of inhaled drugs via the oropharyngeal route and it is impossible to obtain an airtight seal from the inhaler device mouthpiece to the tracheostomy tube. The author describes a simple, effective and cheap modification of a spacer device designed by a creative patient to facilitate delivery of the aerosol via the tracheostomy tube to overcome this problem.

Nebulized Albuterol Delivery in a Model of Spontaneously Breathing Children With Tracheostomy

“…2 Pressurized metered-dose inhalers (pMDIs), nebulizers, and dry powder inhalers have been adapted for aerosol delivery through tracheostomy tubes. [3][4][5][6][7][8][9][10][11][12] A few in vitro studies, mostly using adult models, have provided some information regarding the intricacies of delivering aerosol through an artificial airway. [13][14][15][16] These studies showed that aerosol delivery is significantly affected by tracheostomy tube size, interface, type and configuration of add-on devices, use of assisted breathing, and bias flow.…”

Albuterol delivery via metered dose inhaler in a spontaneously breathing pediatric tracheostomy model

“…Different delivery devices including pressurized metered dose inhalers (pMDI), nebulizers and dry powder inhalers have been adapted to deliver inhaled medications through tracheostomies . Few in vitro studies using adult models have provided some insight into the complexity of aerosol delivery through tracheostomies .…”

Aerosol Therapy in Pulmonary Critical Care

“…Only a few in vitro studies have been done on aerosol delivery through a tracheostomy tube, [106][107][108][109] along with a few case reports on methods used to adapt pMDIs to patients with tracheostomies. [110][111][112] Previous studies found that a measurable amount of aerosol was delivered through the tracheostomy tube regardless of the type of aerosol device used, and aerosol delivery through the tracheostomy tube ranged from 1 to 45% depending on a variety of measurement conditions. [106][107][108][109] Factors affecting pulmonary deposition of aerosols in patients receiving mechanical ventilation are different from those in spontaneously breathing patients.…”