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

Ari, Arzu; Fink, James B.

doi:10.1183/23120541.00027-2021

Cited by 13 publications

(17 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This study shows that aerosol delivery to a simulated adult patient during mechanical ventilation is influenced by the type of aerosol drug delivery device selected, with the VMN delivering the highest drug dose across all testing conducted (see Figures 4, 5 and 6). These findings are in agreement with previous works by Ari and Fink (2021) [28], who reported a drug delivery of 23% from the VMN compared to just 7% for a JN during mechanical ventilation with active humidification. One study showed that the use of a VMN in the emergency department (ED) resulted in a reduction in hospital admissions, length of stay in the ED and albuterol drug dose when compared to a JN [29].…”

Section: Effect Of Device Type On Drug Deliverysupporting

confidence: 94%

Evaluation of Aerosol Drug Delivery Options during Adult Mechanical Ventilation in the COVID-19 Era

et al. 2021

View full text Add to dashboard Cite

Drug delivery devices used for aerosol therapy during mechanical ventilation to ease the symptoms of respiratory diseases provide beneficial treatment but can also pose challenges. Reflecting the significant changes in global guidance around aerosol usage and lung-protective ventilation strategies, seen in response to the COVID-19 pandemic, for the first time, we describe the drug delivery performance of commonly used devices under these conditions. Here, vibrating mesh nebuliser (VMN), jet nebuliser (JN) and pressurised metered-dose inhaler (pMDI) performance was assessed during simulated adult mechanical ventilation. Both standard test breathing patterns and those representatives of low tidal volume (LTV) ventilation with concurrent active and passive humidification were investigated. Drug delivery using a VMN was significantly greater than that with a JN and pMDI for both standard and LTV ventilation. Humidification type did not affect the delivered dose across all device types for standard ventilation. Significant variability in the pMDI dosing was evident, depending on the timing of actuation and the adapter type used. pMDI actuation synchronised with inspiration resulted in a higher delivered drug dose. The type of adapter used for pMDI actuation influenced drug delivery, with the highest dose observed using the CombiHaler.

show abstract

Section: Effect Of Device Type On Drug Deliverysupporting

confidence: 94%

Evaluation of Aerosol Drug Delivery Options during Adult Mechanical Ventilation in the COVID-19 Era

et al. 2021

View full text Add to dashboard Cite

show abstract

“…They may require dilution with normal saline to allow an adequate nebulization rate. Whereas clinical studies with mesh nebulizers during transnasal aerosol delivery to children are limited, in vitro studies showed higher lung deposition with mesh nebulizers than jet nebulizers in this patient population (Ari, 2019;Ari and Fink, 2021).…”

Section: Advantages Disadvantagesmentioning

confidence: 84%

“…Previous in vitro studies on transpulmonary aerosol drug delivery used various lung models, including either nasal cavities or teaching manikins with anatomical airways to emulate the breathing patterns of preterm babies, infants, and children (Bhashyam et al, 2008;Ari et al, 2011;Sunbul et al, 2015;Alalwan et al, 2019;Li et al, 2019a;Li et al, 2019b;Li et al, 2020;Ari and Fink, 2021;Corcoran, 2021;Bass et al, 2022). It should be noted that particle size exiting the nasal prongs is consistently less than 2.6 microns, independent of prong size or gas flow.…”

Section: Advantages Disadvantagesmentioning

confidence: 99%

Mesh nebulizers enabling transnasal pulmonary delivery of medical aerosols to infants and toddlers: Roles, challenges, and opportunities

Ari

Rubin

Fink

2022

Front. Drug. Deliv.

Self Cite

View full text Add to dashboard Cite

The development of mesh nebulizer technology has expanded the ability to deliver medical aerosols to infants and small children via nasal cannula and prongs. Mesh nebulizers do not require compressed gas to generate aerosols and have a smaller, lighter profile facilitating placement in delivery circuits, unlike ultrasonic nebulizers. Prior to this century, aerosol delivery with the nasal interface to 1–4 kg infants or surrogate animal models was limited to low single-digit deposition. In vitro and animal studies with the enabling mesh technology increase inhaled dose by upwards of 14% when nasal continuous positive airway pressure ventilation is in use. Recently, investigations of transnasal aerosol delivery to the lung have expanded to include nasal cannula interfaces with both high and low flow oxygen administration, nasal continuous positive airway pressure therapy, and nasal noninvasive ventilation in treating respiratory distress, respiratory insufficiency, and acute respiratory failure of infants and toddlers. We will first examine the progression of testing transpulmonary delivery of medical aerosols from in vitro models to in vivo animal and human studies. Then, we will explain current and developing applications in clinical practice to view future directions and opportunities.

show abstract

“…[18,19] They aerosolise solutions via a rapidly vibrating piezo element [20] and their clinical superiority over conventional jet nebulisers (JN) has been demonstrated in multiple studies. [21][22][23][24] VMN also have multiple practical advantages over JN and ultrasonic nebulisers, such as faster treatment times, lower residual volumes and in-line usage and are widely regarded as the future of nebulisation. [19,25] VMN may offer a more effective route for the administration of nebulised normal saline in critical care secretion management compared to traditional JN.…”

Section: Introductionmentioning

confidence: 99%

Prospective randomised unblinded comparison of sputum viscosity for three methods of saline nebulisation in mechanically ventilated patients: a study protocol

Arnott

Hart

McQueen

et al. 2022

Preprint

View full text Add to dashboard Cite

Background Heat and moisture exchanger (HME) filters are commonly used as passive circuit humidifiers during mechanical ventilation, however, are only ~ 80% efficient. As a result, patients that undergo mechanical ventilation in critical care with HME filter circuits will be exposed to partial airway humidification. This is associated with detrimental effects including increased secretion load which has been shown to be an independent predicter of failed extubation and poor outcome. Nebulised normal saline is commonly utilised to supplement circuit humidification in ventilated patients with high secretion loads, although there are no randomised control trials evaluating its use in critical care. Novel vibrating mesh nebulisers generate a fine aerosol resulting in deeper lung penetration, potentially offering a more effective means of nebulising normal saline in comparison to jet nebulisers. The primary aim of this study is to compare the viscosity of respiratory secretions after treatment with nebulised normal saline administered via vibrating mesh nebuliser or jet nebuliser. Methods This randomised controlled trial is enrolling 60 mechanically ventilated adult critical care patients breathing on HME filter circuits with high secretion loads. Recruited patients will be randomised to receive nebulised saline via 3 modalities: 1) Continuous vibrating mesh nebuliser; 2) Intermittent vibrating mesh nebuliser or 3) Intermittent jet nebuliser. Over the 72-hr study period, the patients’ sputum viscosity (measured using a validated qualitative sputum assessment tool) and physiological parameters will be recorded by an unblinded assessor. Total secretion volume and any HME filter changes will also be recorded, in addition to a bedside nurse satisfaction questionnaire. A median reduction in secretion viscosity of ≥ 0.5 on the qualitative sputum assessment score will be deemed as a clinically significant improvement between treatment groups. Discussion Nebulised normal saline is commonly utilised for critical care patients with high secretion loads but no randomised control trials exist to guide the technology used or frequency of administration. Novel vibrating mesh technology may also be superior to traditional jet nebulisation for nebuliser delivery. A better understanding of the changes in sputum viscosity after normal saline nebulisation will help improve secretion management during mechanical ventilation. Trial Registration https://www.clinicaltrials.gov/ct2/show/NCT05635903

show abstract

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

Cited by 13 publications

References 31 publications

Evaluation of Aerosol Drug Delivery Options during Adult Mechanical Ventilation in the COVID-19 Era

Evaluation of Aerosol Drug Delivery Options during Adult Mechanical Ventilation in the COVID-19 Era

Mesh nebulizers enabling transnasal pulmonary delivery of medical aerosols to infants and toddlers: Roles, challenges, and opportunities

Prospective randomised unblinded comparison of sputum viscosity for three methods of saline nebulisation in mechanically ventilated patients: a study protocol

Contact Info

Product

Resources

About