Aerosol Delivery Using Jet Nebulizer and Vibrating Mesh Nebulizer During High Frequency Oscillatory Ventilation: An <i>In Vitro</i> Comparison

Fang, Tien-Pei; Lin, Hui-Ling; Chiu, Shu-Hua; Wang, Szu-Hui; DiBlasi, Robert M; Tsai, Ying‐Huang; Fink, James B.

doi:10.1089/jamp.2015.1265

Cited by 17 publications

(16 citation statements)

References 19 publications

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“…Our data also confirms similar findings with DiBlasi et al (27) who observed greater nebulized iloprost delivery in the proximal than distal position for their neonatal model. Generally as model size increases drug delivery tends to increase as well in in-vitro studies due to the advantages of increased tidal volumes, and larger bore circuitry (15, 23). We speculate that the larger observed differences in drug delivery in the distal position with adult testing may be best explained by the reservoir-like effect of the aerosol gathering in the inspiratory limb during exhalation which may result in a larger bolus of drug delivered to the lungs than when the nebulizer is placed proximally.…”

Section: Discussionmentioning

confidence: 99%

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Inhaled Treprostinil Drug Delivery During Mechanical Ventilation and Spontaneous Breathing Using Two Different Nebulizers

Parker

Shen²,

Zheng³

et al. 2017

Pediatric Critical Care Medicine

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Objective To determine the feasibility of delivering inhaled treprostinil during mechanical ventilation and spontaneous unassisted ventilation using the Tyvaso Inhalation System (TIS), and t Vibrating Mesh Nebulizer (VMN). We sought to compare differences in fine particle fraction (FPF), and absolute inhaled treprostinil mass delivered to neonatal, pediatric, and adult models affixed with a facemask, conventional, and high frequency ventilation between TIS and with different nebulizer locations between TIS and VMN. Design FPF was first determined via cascade impaction with both the TIS and VMN. Next, a test lung, configured with neonatal, pediatric, and adult mechanics and a filter to capture medication was attached to a realistic face model during spontaneous breathing or an ETT during conventional ventilation and HFOV. Inhaled treprostinil was then nebulized with both the TIS, and VMN, and the filter was analyzed via HPLC. Testing was done in triplicate. Independent two-sample t-tests were used to compare mean FPF, and inhaled mass between devices. ANOVA with Tukey post-hoc tests were used to compare within device differences. Setting Academic children’s hospital aerosol research laboratory. Measurements and Main Results FPF was not different between the TIS and VMN (0.78 ± 0.04 vs 0.77 ± 0.08, respectively, P = 0.79). The VMN delivered the same or greater inhaled treprostinil than the TIS in every simulated model and condition. When using the VMN, delivery was highest when using HFOV in the neonatal and pediatric models, and with the nebulizer in the distal position in the adult model. Conclusion The VMN is a suitable alternative to the TIS for inhaled treprostinil delivery. FPF is similar between devices, and VMN delivery meets or exceeds delivery of the TIS. Delivery for infants and children during HFOV with the VMN may result in higher than expected dosages.

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Section: Discussionmentioning

confidence: 99%

“…During HFOV, nebulizer placement in the Distal Position has been shown to deliver negligible medication (15) thus only delivery in the Proximal Position was tested (nebulizer placed between patient wye connector and ETT) (Figure 1B). …”

Section: Methodsmentioning

confidence: 99%

Inhaled Treprostinil Drug Delivery During Mechanical Ventilation and Spontaneous Breathing Using Two Different Nebulizers

Parker

Shen²,

Zheng³

et al. 2017

Pediatric Critical Care Medicine

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“…MV is used for the most seriously ill and critical patients, but more recently there has been a general trend towards less invasive means of ventilatory support for many such patients. [54][55][56] 52,[60][61][62][63] These investigations generally showed that aerosol devices are more efficient when placed at the ventilator or humidifier and less efficient at or near the Y-piece when bias flow was present ( Figure 1). 61 Berlinski and Willis showed that a VMN delivers ninefold more aerosol dose compared with a JN during simulated mechanical ventilation.…”

Section: The Vibrating Mesh Nebulisermentioning

confidence: 99%

Inducible Laryngeal Obstruction in the Paediatric Population – Review of the Literature and Current Understanding

Soares¹,

Rodrigues²,

Morais‐Almeida³

2018

European Respiratory &Amp; Pulmonary Diseases

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Inducible laryngeal obstruction (ILO) is a complex entity and its exact mechanisms are still unclear. It is characterised by transient and reversible narrowing of the larynx in response to external triggers, resulting in symptoms such as cough, dyspnoea and noisy breathing. The prevalence of this condition in adult or paediatric populations is uncertain. Management of ILO starts by establishing an accurate diagnosis, and treatment includes control of trigger factors, breathing and relaxation techniques, and speech and respiratory therapy. The aim of this article is to summarise current understanding and provide a review of the literature of ILO in the paediatric population.

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“…Several in vitro studies demonstrated decreased delivered drug doses from nebulisers when humidification was placed within the circuit , as well as in vivo evidence of the same effect in adults inhaling nebulised antibiotics . Moreover, placement of aerosol‐generating devices proximal to the humidifier within the circuit results in very limited drug delivery in in vitro models . Despite the known effect of humidification on nebuliser effectiveness, the risk of damaging the patients airway by inhaling dry air and disconnecting the ventilator circuit means that it may be more appropriate to increase the period of treatment with a nebuliser, rather than discontinuing humidification .…”

Section: Impact Of Respiratory Support Equipment On Drug Deliverymentioning

confidence: 99%

Current options in aerosolised drug therapy for children receiving respiratory support

et al. 2017

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Inhalation of aerosolised medications are the mainstay of treatment for a number of chronic lung diseases and have several advantages over systemically-administered medications. These include more rapid onset of action for drugs such as β-adrenergic agonists when compared with oral medication, high luminal doses for inhaled antibiotics when used to treat endobronchial infection, and an improved therapeutic index compared with systemic delivery for these and other classes of drugs such as corticosteroids. The use of aerosolised drugs to treat patients whose tracheas are intubated is less well established, in part because systemic delivery via the intravenous route can be a simpler alternative for many drugs. Consequently, research in this area is largely limited to a number of in vitro studies and very few clinical trials. Unfortunately, a lack of focus in this area has resulted in a number of practices which at best are ineffective, and at worst dangerous for the patient. Although there have been some attempts to re-invigorate research in order to improve delivery systems, current devices are, to a great extent, based on long-standing technology developed more than 50 years ago. In this review, we explore current knowledge and provide guidance as to when and how the inhaled route may be of value when treating patients whose tracheas are intubated, and we set out the challenges facing those attempting to advance the topic. We conclude by reviewing current areas of interest that may lead to more effective and widespread use of aerosols in the treatment of intubated patients.

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Aerosol Delivery Using Jet Nebulizer and Vibrating Mesh Nebulizer During High Frequency Oscillatory Ventilation: An In Vitro Comparison

Abstract: During HFOV, aerosol delivery with the nebulizer placed at proximal was greater than placement distal from the ETT, with VMN delivering more drug than JN. The inhaled drug was delivery correlated positively with ETT size, MAP, and bias flow, and inversely proportional to power settings.

Cited by 17 publications

References 19 publications

Inhaled Treprostinil Drug Delivery During Mechanical Ventilation and Spontaneous Breathing Using Two Different Nebulizers

Inhaled Treprostinil Drug Delivery During Mechanical Ventilation and Spontaneous Breathing Using Two Different Nebulizers

Inducible Laryngeal Obstruction in the Paediatric Population – Review of the Literature and Current Understanding

Current options in aerosolised drug therapy for children receiving respiratory support

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