Enhanced delivery of nebulised salbutamol during non-invasive ventilation

Calvert, Lori D; Jackson, J; White, Judy A.; Barry, Peter; Kinnear, William; O’Callaghan, Christopher

doi:10.1211/jpp.58.11.0017

Cited by 44 publications

(38 citation statements)

References 15 publications

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“…Similar to our findings and at comparable peak pressures, they observed a 2-fold greater increase in drug delivery when the nebulizer was moved away from the BPAP ventilator and placed after the leak port and proximal to the face mask. Calvert et al 25 nebulized salbutamol with a jet nebulizer at 3 similar positions during simulated adult NIV. Like our study and previous studies, drug delivery was half the value when the nebulizer was placed back at the ventilator, compared with proximal to the patient.…”

Section: Discussionmentioning

confidence: 99%

Bronchodilator Delivery During Simulated Pediatric Noninvasive Ventilation

et al. 2013

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BACKGROUND: Noninvasive ventilation (NIV) is usually applied using bi-level positive airway pressure devices, and many of these devices use a single-limb patient circuit with an integrated leak port to purge the circuit of exhaled carbon dioxide. Sometimes bronchodilator therapy is indicated in pediatric patients, but there have been no studies of the optimal nebulizer position, with respect to leak, during pediatric NIV. We hypothesized that there would be no differences in albuterol delivery with a vibrating-mesh nebulizer between 3 different positions/exhalation leak valve combinations in the patient circuit during simulated pediatric NIV. METHODS: A simulated upper airway model was attached to a lung model that simulated spontaneous breathing. A noninvasive ventilator equipped with heated wire circuit and heated humidifier was attached to the lung model via a pediatric oronasal mask. Albuterol (5 mg) was delivered with a vibrating-mesh nebulizer, at 3 different circuit position/leak condition combinations: prior to the humidifier and leak valve; between the humidifier and leak valve; and integrated within the mask and after the leak. Albuterol was captured on a filter and quantified with chromatography. RESULTS: Greater albuterol mass was delivered to the filter with the nebulizer integrated into the mask than at any other testing condition (P < .001). In the conditions where the nebulizer was placed prior to the exhalation leak valve, greater drug delivery was observed when the nebulizer was placed proximal to the mask (position 2) than when placed prior to the humidifier (position 3, P ‫؍‬ .002). CONCLUSIONS: Albuterol delivery during simulated pediatric NIV was affected by the position of the nebulizer in relation to the expiratory leak valve and the nebulizer's distance from the filter. A vibrating-mesh nebulizer placed intra-mask may provide a better alternative for medication delivery than those previously used during pediatric NIV.

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Section: Discussionmentioning

confidence: 99%

Bronchodilator Delivery During Simulated Pediatric Noninvasive Ventilation

et al. 2013

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“…Nebuliser efficiency is higher with the leak port in the circuit, as compared with a leak port in the facemask [132]. Furthermore, the findings of CALVERT et al [132] suggest that a nebuliser placed between the ventilator and leak port (ventilator, nebuliser, leak port, facemask) performs with higher efficiency than placement of the nebuliser between the leak port (ventilator, leak port, nebuliser, facemask).…”

Section: Recommendationsmentioning

confidence: 99%

What the pulmonary specialist should know about the new inhalation therapies

et al. 2011

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A collaboration of multidisciplinary experts on the delivery of pharmaceutical aerosols was facilitated by the European Respiratory Society (ERS) and the International Society for Aerosols in Medicine (ISAM), in order to draw up a consensus statement with clear, up-to-date recommendations that enable the pulmonary physician to choose the type of aerosol delivery device that is most suitable for their patient. The focus of the consensus statement is the patientuse aspect of the aerosol delivery devices that are currently available.The subject was divided into different topics, which were in turn assigned to at least two experts. The authors searched the literature according to their own strategies, with no central literature review being performed. To achieve consensus, draft reports and recommendations were reviewed and voted on by the entire panel.Specific recommendations for use of the devices can be found throughout the statement. Healthcare providers should ensure that their patients can and will use these devices correctly. This requires that the clinician: is aware of the devices that are currently available to deliver the prescribed drugs; knows the various techniques that are appropriate for each device; is able to evaluate the patient's inhalation technique to be sure they are using the devices properly; and ensures that the inhalation method is appropriate for each patient.

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“…In contrast, application of positive pressure reduces aerosol particle size, increases tidal volume, and reduces breathing frequency, all of which tend to enhance aerosol delivery. [23][24][25][26] Moreover, an increase in expiratory time due to a slower breathing frequency could enhance particle sedimentation and alter the pattern of drug deposition during exhalation. 24 Our study has some limitations.…”

Section: Discussionmentioning

confidence: 99%