Blow-by as Potential Therapy for Uncooperative Children: An In-Vitro Study

Mansour, Mohamed Mohsen; Smaldone, Gerald C.

doi:10.4187/respcare.01653

Cited by 8 publications

(8 citation statements)

References 11 publications

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“…[35][36][37][38] One study 39 showed the opposite effect in a pediatric lung model, wherein a standard bottom-loaded aerosol mask resulted in greater drug delivery than a frontloaded design. It is important to note that a common nebulizer was not used with each of the different face masks during the testing, so it is unclear if these results were based solely on the mask or the nebulizer being used.…”

Section: Interface Selectionmentioning

confidence: 99%

Clinical Controversies in Aerosol Therapy for Infants and Children

DiBlasi

2015

Respir Care

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Pediatric patients are different from adult patients with respect to airway anatomy and breathing patterns. They are also incapable of following commands and often reject breathing treatments. For these reasons, aerosol drug delivery is one of the most technically challenging aspects for clinicians providing respiratory care to young children. Improvements in nebulizer technology have provided better delivery options for pediatric patients. This review highlights research related to pediatric nebulizer and interface devices and how they can be used to provide the safest and most efficient treatments with the array of treatment delivery options. Also addressed are clinical controversies and debates in pediatric aerosol science, including drug delivery in crying versus resting infants, pressurized metered-dose inhalers and small-volume nebulizers for bronchodilator administration, continuous nebulization, noninvasive drug delivery options, and optimization of nebulizer performance during infant and large pediatric conventional and high-frequency ventilation.

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Section: Interface Selectionmentioning

confidence: 99%

Clinical Controversies in Aerosol Therapy for Infants and Children

DiBlasi

2015

Respir Care

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“…11,12,27 Lin et al 11 compared the effect of front-loaded versus angle-loaded and bottomloaded masks on inhaled mass behind the oral opening of a mannequin face when delivering the aerosol with a jet nebulizer placed 0, 1, and 2 cm from the face using an infant breathing pattern (V T of 60 mL, breathing frequency of 20 breaths/min, inspiratory time of 0.7 s). The frontloaded nebulizer was the most efficient interface and showed a 38% decrease in inhaled mass when the mask was moved 2 cm from the face.…”

Section: Interfacesmentioning

confidence: 99%

“…As stated previously, other non-anatomically correct models overestimate drug delivery to infants and children. 11,12,[26][27][28] Three other nasal interfaces were used: the VixOne PediNeb pacifier with an angled connector or with a T-piece connector and the B&B pacifier adapter. With the jet nebulizer, the nasal interfaces showed equivalent lung dose to the face mask placed 2 cm from the face when used with the infant and newborn breathing patterns, but lower lung dose with the child breathing pattern.…”

Section: Interfacesmentioning

confidence: 99%

“…24,25 Other authors evaluated drug delivery using mouthbreathing models. 11,[26][27][28] Because infants and young children are obligate nose breathers, studies utilizing the nasal route for aerosol delivery are of importance. [29][30][31] Recently, Amirav et al 31 reported that nasal breathing resulted in larger lung deposition than mouth breathing in an in vivo study using airway replicas of 5-, 14-, and 20-month-old infants and toddlers.…”

Section: Introductionmentioning

confidence: 99%

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In Vitro Evaluation of Aerosols Delivered via the Nasal Route

Taoum

Kim

et al. 2015

Respir Care

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BACKGROUND: Infants and young children are obligate nose breathers; therefore, a transnasal route seems the logical delivery method of inhaled aerosols. The efficiency of aerosol delivery depends on several factors, such as interface, type of nebulizer, and patient age and breathing pattern. We hypothesized that the use of a vibrating mesh nebulizer, a tight-fitting face mask, and a head model and breathing pattern of an older child would result in a higher lung dose. We also hypothesized that the use of an anatomically correct model would more accurately reflect lung dose than models that do not include airways. METHODS: A model comprising a breathing simulator and an anatomically correct model of a 7-month-old infant and a 5-y-old child with an interposed collection filter (lung dose) were used. Breathing patterns of a newborn, infant, and child were used with 7 interfaces. A continuous output and a vibrating mesh nebulizer were loaded with albuterol sulfate solution (5 mg/3.5 mL) and operated for 5 min. Albuterol mass was determined via spectrophotometer (276 nm). RESULTS: Lung dose varied between 0 and 3%. The jet nebulizer was more efficient than the vibrating mesh nebulizer. The front-loaded mask was the most efficient interface. We also found that higher tidal volumes were associated with higher lung doses and that the use of a larger airway model resulted in a lower lung dose. Finally, the model showed a good correlation with in vivo data and rendered lung doses severalfold lower than previous data obtained with oral models. CONCLUSIONS: Careful pairing of the aerosol generator and interface is very important during transnasal aerosol delivery.

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“…17 Three commercially available nebulizer/compressor/face mask systems (Pari Sprint, Respironics Sidestream, and Salter 8900) were used to nebulize budesonide at 0, 2, and 4 cm from the face. Inhaled drug mass and the deposition on face, eyes, and mask were measured.…”

Section: See the Original Study On Page 2004mentioning

confidence: 99%

Is It Time to Say Good Bye to Blow-By?

Restrepo

2012

Respir Care

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Blow-by as Potential Therapy for Uncooperative Children: An In-Vitro Study

Cited by 8 publications

References 11 publications

Clinical Controversies in Aerosol Therapy for Infants and Children

Clinical Controversies in Aerosol Therapy for Infants and Children

In Vitro Evaluation of Aerosols Delivered via the Nasal Route

Is It Time to Say Good Bye to Blow-By?

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