Factors affecting bronchodilator delivery in mechanically ventilated adults

Ari, Arzu; Fink, James B.

doi:10.1111/j.1478-5153.2010.00395.x

Cited by 53 publications

(41 citation statements)

References 45 publications

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“…Heat and humidity: Bench models of mechanical ventilation clearly established that aerosol drug delivery is reduced by up to 40% in heated/humidified ventilator circuits compared to nonhumidified unheated circuits. (5,6,20,(30)(31)(32) Although higher deposition with delivery of cold dry gas might seem attractive as a means to deliver more drug to the lung, the increased efficiency of aerosol delivery must be weighed against the potential deleterious effects of prolonged ventilation with cold dry gases. (32) Active heated humidifiers are commonly used during mechanical ventilation of infants and small children, and a substantial proportion of adults.…”

Section: Factors Influencing Aerosol Delivery During Mechanical Ventimentioning

confidence: 99%

“…(5,6,20,(30)(31)(32) Although higher deposition with delivery of cold dry gas might seem attractive as a means to deliver more drug to the lung, the increased efficiency of aerosol delivery must be weighed against the potential deleterious effects of prolonged ventilation with cold dry gases. (32) Active heated humidifiers are commonly used during mechanical ventilation of infants and small children, and a substantial proportion of adults. The heat and humidity of an inhaled gas to body temperature pressure saturated (BTPS) conditions promotes mucociliary clearance, prevents drying of the airway mucosa, and reduces bronchospastic responses to breathing cold dry air.…”

Section: Factors Influencing Aerosol Delivery During Mechanical Ventimentioning

confidence: 99%

See 1 more Smart Citation

Inhalation Therapy in Patients Receiving Mechanical Ventilation: An Update

Ari

Fink

Dhand

2012

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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Incremental gains in understanding the influence of various factors on aerosol delivery in concert with technological advancements over the past 2 decades have fueled an ever burgeoning literature on aerosol therapy during mechanical ventilation. In-line use of pressurized metered-dose inhalers (pMDIs) and nebulizers is influenced by a host of factors, some of which are unique to ventilator-supported patients. This article reviews the impact of various factors on aerosol delivery with pMDIs and nebulizers, and elucidates the correlation between in-vitro estimates and in-vivo measurement of aerosol deposition in the lung. Aerosolized bronchodilator therapy with pMDIs and nebulizers is commonly employed in intensive care units (ICUs), and bronchodilators are among the most frequently used therapies in mechanically ventilated patients. The use of inhaled bronchodilators is not restricted to mechanically ventilated patients with chronic obstructive pulmonary disease (COPD) and asthma, as they are routinely employed in other ventilator-dependent patients without confirmed airflow obstruction. The efficacy and safety of bronchodilator therapy has generated a great deal of interest in employing other inhaled therapies, such as surfactant, antibiotics, prostacyclins, diuretics, anticoagulants and mucoactive agents, among others, in attempts to improve outcomes in critically ill ICU patients receiving mechanical ventilation.

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Section: Factors Influencing Aerosol Delivery During Mechanical Ventimentioning

confidence: 99%

Section: Factors Influencing Aerosol Delivery During Mechanical Ventimentioning

confidence: 99%

Inhalation Therapy in Patients Receiving Mechanical Ventilation: An Update

Ari

Fink

Dhand

2012

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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“…Upon review of the literature, the following research questions arose. (1) What is the amount of drug deposition with a jet nebulizer and pMDI in simulated mechanically ventilated adult models with TTs and ETTs? (2) What is the difference between a jet nebulizer and pMDI in delivery efficiencies in simulated ventilator-dependent adults with artificial airways?…”

Section: Introductionmentioning

confidence: 99%

“…However, providing effective aerosol therapy is a complex procedure that is influenced by many factors. [1][2][3][4][5] Achieving success in aerosol therapy in patients with artificial air-ways depends on both the efficiency of aerosol devices and the type of artificial airways used.…”

Section: Introductionmentioning

confidence: 99%

Pressurized Metered-Dose Inhalers Versus Nebulizers in the Treatment of Mechanically Ventilated Subjects With Artificial Airways: An In Vitro Study

et al. 2015

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A jet nebulizer and pressurized metered-dose inhaler (pMDI) were placed in the inspiratory limb of the circuit 15 cm from the Y-adapter. The jet nebulizer was operated at 8 L/min to deliver albuterol sulfate (2.5 mg/3 mL), whereas an albuterol pMDI was actuated 4 times with a spacer. Drug was eluted from the filter and analyzed by spectrophotometry. RESULTS: Drug delivered via a TT was marginally greater compared with an ETT using the jet nebulizer and pMDI (P ‫؍‬ .10 and .046, respectively). Although delivery efficiency with the pMDI was 3-fold greater than with the jet nebulizer with both a TT and an ETT (P ‫؍‬ .001 and .002, respectively), the jet nebulizer delivered greater drug mass compared with the pMDI with either a TT (P ‫؍‬ .01) or an ETT (P ‫؍‬ .005). CONCLUSIONS: Aerosol drug delivery via a TT was greater than with an ETT, whereas the delivery efficiency of a pMDI via either airway was greater than that of a jet nebulizer.

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“…It has been suggested that placement of nebulizers prior to humidifier can improve drug delivery distal to artificial airway in mechanically ventilated adult and pediatric patients in presence of bias flow, [4][5][6] patients receiving gas via high flow nasal cannula (HFNC), [7,8] as well as infants receiving nasal continuous positive airway pressure (nCPAP) and synchronized inspiratory positive airway pressure (Si PAP) [9]. While placement of aerosol generator at inlet of humidifier has been shown to improve aerosol delivery efficiency from range of nebulizers, it is not known whether aerosolized drug that rains out into the heated humidifier could result in undesirable drugs changes that could have undesirable effect on patient.…”

Section: Introductionmentioning

confidence: 99%

Stability of commonly nebulized drugs in heated and humid condition

Saeed¹,

Abdelrahim²,

Fink³

2018

Med-Science

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Placement of nebulizer prior to heated humidifier has been reported to improve efficiency of aerosol delivery during ventilator support. Drugs nebulized in this position must travel through humidifier, rainout in reservoir and may be subjected to extended periods of heat up to 50°C. Toxic degradation may develop, posing potential risk to patient. The aim of this study was to evaluate chemical stability of commonly inhaled drugs administered to mechanically ventilated patients subjected to extended period of 50°C. Formulations of 8 comonly inhaled drugs were diluted to 50 mL total volume in water and exposed to 50oC for 7 days to simulate effect of heat in humidifier. High Performance Liquid Chromatography (HPLC) was performed before and after heating to determine drug stability and degradation. Drug integrity, color or pH changes were noted. Epinephrine, levalbuterol, tobramycin and colistin demonstrated>10% reduction in concentration but only acetylcysteine had additional peaks in HPLC chromatogram demonstrating potential degradation and possible production of by product. Changes in color were observed with epinephrine and acetylcysteine. All drugs retained their integrity after subjecting them to 50oC for 7 days except acetylcysteine. Acetylcysteine changed color and had new peak in HPLC chromatogram. Color change with epinephrine was not associated with any new peak in HPLC chromatogram. Further studies should determine whether acetylcysteine changes would result in any off gassing of vapor that might harm the patient.

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Factors affecting bronchodilator delivery in mechanically ventilated adults

Cited by 53 publications

References 45 publications

Inhalation Therapy in Patients Receiving Mechanical Ventilation: An Update

Inhalation Therapy in Patients Receiving Mechanical Ventilation: An Update

Pressurized Metered-Dose Inhalers Versus Nebulizers in the Treatment of Mechanically Ventilated Subjects With Artificial Airways: An In Vitro Study

Stability of commonly nebulized drugs in heated and humid condition

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