In VitroComparison of Five Nebulizers During Noninvasive Ventilation: Analysis of Inhaled and Lost Doses

Abstract

In a single-limb circuit bilevel ventilator, vibrating mesh nebulizers positioned between the exhalation port and lung model are more efficient for drug delivery compared with jet or ultrasonic nebulizers. In this position, the improved efficiency of vibrating mesh nebulizers was due to an increase in the inhaled dose and a reduction in the exhaled wasted dose compared with placement between the ventilator and the expiratory port. Because of the high total lost dose, the ultrasonic device should not be recommended. Nebulizer placement before the exhalation port increased the inhaled dose and decreased the expiratory wasted dose, except for the jet nebulizer.

Which Nebulizer Position Should Be Avoided? An Extended Study of Aerosol Delivery and Ventilator Performance during Noninvasive Positive Pressure Ventilation

“…Aerosol delivery reported in other studies has also been lower than that found in our study [8, 11, 13], perhaps because of a suboptimal selection of nebulizer location in previous research or because a shorter nebulization time (10 min) was used than the time used in our study (approx. 13 min).…”

“…Of 5 previous studies [8, 9, 11-13] (Table 1), 1 reported that the proximal position gave higher delivery [9], 2 reported that the distal position had higher delivery [12, 13], and the other 2 studies gave inconsistent results [8, 11]. These discrepancies may be partly explained by differences in the distance between the nebulizer position and the exhalation valve in different studies, as well as the differences in experimental conditions used (Table 1).…”

Aerosol Therapy During Noninvasive Ventilation or High-Flow Nasal Cannula

“…Michotte et al 14 used an adult lung model of NIV with a bi-level ventilator to compare inhaled and lost doses of 5 nebulizers and the influence of nebulizer position. The lung model was set to generate a frequency of 15 breaths/ min.…”

Pulmonary Drug Delivery Following Continuous Vibrating Mesh Nebulization and Inspiratory Synchronized Vibrating Mesh Nebulization During Noninvasive Ventilation in Healthy Volunteers

“…(3,(12)(13)(14)(15) Recently, some technical issues regarding drug nebulization during NIPPV using a single-limb circuit bilevel ventilator were investigated and resolved with the help of bench studies. (12,14,(16)(17)(18) These studies concluded that the optimal position of the nebulizer device was between the patient and the passive exhalation port. (3,12,14,15,18) Moreover, they showed that vibrating mesh nebulizer devices were more efficient than jet nebulizer devices.…”

“…(12,14,(16)(17)(18) These studies concluded that the optimal position of the nebulizer device was between the patient and the passive exhalation port. (3,12,14,15,18) Moreover, they showed that vibrating mesh nebulizer devices were more efficient than jet nebulizer devices. (12,13,18) Although the use of breath-synchronized nebulizers could potentially improve aerosol delivery during NIPPV, (19)(20)(21) this technical aspect has been little studied because breathsynchronized nebulizers are currently not commercially available for use with bilevel ventilators.…”