A mesh nebulizer is more effective than jet nebulizer to nebulize bronchodilators during non-invasive ventilation of subjects with COPD: A randomized controlled trial with radiolabeled aerosols

Galindo-Filho, Valdecir Castor; Alcoforado, Luciana; Rattes, Catarina; Paiva, Dulciane Nunes; Brandão, Simone Cristina Soares; Fink, James B.

doi:10.1016/j.rmed.2019.05.016

Cited by 41 publications

(34 citation statements)

References 30 publications

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“…In this study, there were only small differences between NIV and IMV with respect to the delivered aerosol dose (19.02% versus 22.64% respectively). Again, these figures are in line with previous published reports [ 51 , 52 ].…”

Section: Discussionsupporting

confidence: 93%

Evaluation of Aerosol Therapy during the Escalation of Care in a Model of Adult Cystic Fibrosis

et al. 2021

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Lung disease is the main cause of morbidity and mortality in cystic fibrosis (CF). CF patients inhale antibiotics regularly as treatment against persistent bacterial infections. The goal of this study was to investigate the effect of clinical intervention on aerosol therapy during the escalation of care using a bench model of adult CF. Droplet size analysis of selected antibiotics was completed in tandem with the delivered aerosol dose (% of total dose) assessments in simulations of various interventions providing oxygen supplementation or ventilatory support. Results highlight the variability of aerosolised dose delivery. In the homecare setting, the vibrating mesh nebuliser (VMN) delivered significantly more than the jet nebuliser (JN) (16.15 ± 0.86% versus 6.51 ± 2.15%). In the hospital setting, using VMN only, significant variability was seen across clinical interventions. In the emergency department, VMN plus mouthpiece (no supplemental oxygen) was seen to deliver (29.02 ± 1.41%) versus low flow nasal therapy (10 L per minute (LPM) oxygen) (1.81 ± 0.47%) and high flow nasal therapy (50 LPM oxygen) (3.36 ± 0.34%). In the ward/intensive care unit, non-invasive ventilation recorded 19.02 ± 0.28%, versus 22.64 ± 1.88% of the dose delivered during invasive mechanical ventilation. These results will have application in the design of intervention-appropriate aerosol therapy strategies and will be of use to researchers developing new therapeutics for application in cystic fibrosis and beyond.

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Section: Discussionsupporting

confidence: 93%

Evaluation of Aerosol Therapy during the Escalation of Care in a Model of Adult Cystic Fibrosis

et al. 2021

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“…More recently, G alindo- F ilho et al [ 32 ], comparing the delivery of radiolabelled aerosol during NIV with jet and mesh nebulisers in moderate-to-severe COPD, patient-reported lung doses of 3.14% with a jet nebuliser versus 12.05% with a mesh nebuliser. Their lower reported lung dose than our in vitro reports is probably due to our use of collecting filters that are known to overestimate inhaled dose, and filters do not allow for exhalation of aerosol that occurs in vivo .…”

Section: Discussionmentioning

confidence: 99%

Delivered dose with jet and mesh nebulisers during spontaneous breathing, noninvasive ventilation and mechanical ventilation using adult lung models

Ari

Fink

2021

ERJ Open Res

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What is the delivered dose with jet (JN) and mesh nebulizers (MN) during spontaneous breathing (SB), noninvasive ventilation (NIV), and mechanical ventilation (MV) using an adult lung model with exhaled humidity (EH)? Albuterol sulfate (2.5 mg·3 mL−1) delivery with JN (Mistymax10) and MN (AerogenSolo) was compared during SB, NIV, and MV using breathing parameters (Vt=450 mL, RR=20 bpm, I:E=1:3) with three lung models simulating EH. A manikin was attached to a sinusoidal pump via a filter at the bronchi to simulate an adult with SB. A ventilator (V60) was attached via a facemask to a manikin with a filter at the bronchi connected to a test lung to simulate an adult receiving NIV. A ventilator-dependent adult was simulated through a ventilator (Servo i) operated with a heated humidifier (Fisher&Paykel) attached to an ETT with a heated-wire circuit. The ETT was inserted into a filter (RespirgardII). A heated humidifier was placed between the filter and test lung to simulate EH (35±2° C, 100% RH). Nebulizers were placed at the Y-piece of the inspiratory limb during MV and positioned between the facemask and the leak-port during NIV. A mouthpiece was used during SB. The delivered dose was collected in an absolute filter that was attached to the bronchi of the mannequin during each aerosol treatment and measured with spectrohoptometry. Drug delivery during MV was significantly greater than NIV and SB with MN (p=0.0001) but not with JN (p=0.384). Delivery efficiency of MN was greater than JN during MV (p=0.0001), NIV (p=0.0001), and SB (p=0.0001). Drug delivery with MN was greater and differed between MV, NIV, and SB, while deposition was low with JN and similar between the modes of ventilation tested.

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“…The combination of LAMA with LABA therapies has proven effective in COPD treatment, several studies showed their efficacy with inhalers [190,193] so delivery by nebulizer may soon be standard. There are also several clinical trials comparing JN versus VMN in COPD patients with some publications already pointing to preference for VMN [194]. Interestingly, the need for improved patient-orientated personalized care [195], and better adherence to prescription guidelines for asthma patients is also noted.…”

Section: Short-and Long-acting Adrenergic and Muscarinic Agonistsmentioning

confidence: 99%

Future Trends in Nebulized Therapies for Pulmonary Disease

McCarthy

González

Higgins

2020

JPM

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Aerosol therapy is a key modality for drug delivery to the lungs of respiratory disease patients. Aerosol therapy improves therapeutic effects by directly targeting diseased lung regions for rapid onset of action, requiring smaller doses than oral or intravenous delivery and minimizing systemic side effects. In order to optimize treatment of critically ill patients, the efficacy of aerosol therapy depends on lung morphology, breathing patterns, aerosol droplet characteristics, disease, mechanical ventilation, pharmacokinetics, and the pharmacodynamics of cell-drug interactions. While aerosol characteristics are influenced by drug formulations and device mechanisms, most other factors are reliant on individual patient variables. This has led to increased efforts towards more personalized therapeutic approaches to optimize pulmonary drug delivery and improve selection of effective drug types for individual patients. Vibrating mesh nebulizers (VMN) are the dominant device in clinical trials involving mechanical ventilation and emerging drugs. In this review, we consider the use of VMN during mechanical ventilation in intensive care units. We aim to link VMN fundamentals to applications in mechanically ventilated patients and look to the future use of VMN in emerging personalized therapeutic drugs.

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A mesh nebulizer is more effective than jet nebulizer to nebulize bronchodilators during non-invasive ventilation of subjects with COPD: A randomized controlled trial with radiolabeled aerosols

Cited by 41 publications

References 30 publications

Evaluation of Aerosol Therapy during the Escalation of Care in a Model of Adult Cystic Fibrosis

Evaluation of Aerosol Therapy during the Escalation of Care in a Model of Adult Cystic Fibrosis

Delivered dose with jet and mesh nebulisers during spontaneous breathing, noninvasive ventilation and mechanical ventilation using adult lung models

Future Trends in Nebulized Therapies for Pulmonary Disease

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