In Vitro Evaluation of Aerosol Performance and Delivery Efficiency During Mechanical Ventilation Between Soft Mist Inhaler and Pressurized Metered-Dose Inhaler

Ke, Wei-Ren; Wang, Wei-Jhen; Lin, Tzong-Shyan; Wu, Cho‐Kai; Huang, Sheng-Hsiu; Wu, Huey-Dong; Chen, Chih-Chieh

doi:10.4187/respcare.06993

Cited by 12 publications

(5 citation statements)

References 32 publications

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“…The interaction of SMI actuation synchronization and bias flow during mechanical ventilation affects aerosol deposition. Ke reported greater delivered dose during mechanical ventilation with SMI actuation at the beginning of expiration rather than at beginning of inspiration (16.1% vs. 9.8%, retrospectively) [13]. Similarly, we found a significant increase in the aerosol delivery of SMI with the in-line adapter with actuation at the beginning of expiration.…”

Section: Influence Of Actuation Timingsupporting

confidence: 70%

Optimal Connection for Tiotropium SMI Delivery through Mechanical Ventilation: An In Vitro Study

et al. 2020

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We aimed to quantify Soft Mist Inhalers (SMI) delivery to spontaneous breathing model and compare with different adapters via endotracheal tube during mechanical ventilation or by manual resuscitation. A tiotropium SMI was used with a commercial in-line adapter and a T-adapter placed between the Y-adapter and the inspiratory limb of the ventilator circuit during mechanical ventilation. The SMI was actuated at the beginning of inspiration and expiration. In separate experiments, a manual resuscitator with T-adapter was attached to endotracheal tube, collecting filter, and a passive test lung. Drug was eluted from collecting filters with salt-based solvent and analyzed using high-performance liquid chromatography. Results showed the percent of SMI label dose inhaled was 3-fold higher with the commercial in-line adapter with actuation during expiration than when synchronized with inspiration. SMI with T-adapter delivery via ventilator was similar to inhalation (1.20%) or exhalation (1.02%), and both had lower delivery dose than with manual resuscitator (2.80%; p = 0.01). The inhaled dose via endotracheal tube was much lower than inhaled dose with spontaneous breathing (22.08%). In conclusion, the inhaled dose with the commercial adapter was higher with SMI actuated during expiration, but still far less than reported spontaneous inhaled dose.

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Section: Influence Of Actuation Timingsupporting

confidence: 70%

Optimal Connection for Tiotropium SMI Delivery through Mechanical Ventilation: An In Vitro Study

et al. 2020

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“…Ke et al compared three positions for both pMDI and SMI in a ventilator circuit with an adult lung model: (P1) proximal to the endotracheal tube (ETT), (P2) the inspiratory limb at 15 cm from the Y-piece, and (P3) 15 cm from the ventilator (Figure 1). The highest inhaled dose for both inhalers was achieved at (P2) 15 cm from the Y-piece and the lowest dose at (P3) 15 cm from the ventilator (41). The aerosol penetration is an inverse function of the length of tubing (42).…”

Section: Inline Connection Of a Dpi In A Respiratory Circuit For Non-invasive And Invasive Ventilation Therapymentioning

confidence: 97%

“…However, placing the inhalers proximal to the ETT (P1) did not result in the highest inhaled doses. The reason could be that the emitted aerosols immediately encountered high airflow turbulence as they enter the narrow ETT resulting in high impaction loss (39,41). Placing inhalers closer to the Y-piece in the inspiratory limb would provide longer time for the aerosols to adapt to the local fluid velocity, obtaining higher inhaled doses.…”

Section: Inline Connection Of a Dpi In A Respiratory Circuit For Non-invasive And Invasive Ventilation Therapymentioning

confidence: 99%

Administration of dry powders during respiratory supports

Ke¹,

Chang²,

Kwok³

et al. 2021

Ann Transl Med

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Inhaled drugs are routinely used for the treatment of respiratory-supported patients. To date, pressurized metered dose inhalers and nebulizers are the two platforms routinely employed in the clinical setting. The scarce utilization of the dry powder inhaler (DPI) platform is partly due to the lack of in vivo data that proves optimal delivery and drug efficacy are achievable. Additionally, fitting a DPI in-line to the respiratory circuit is not as straightforward as with the other aerosol delivery platforms. Importantly, there is a common misconception that the warm and humidified inspiratory air in respiratory supports, even for a short exposure, will deteriorate powder formulation compromising its delivery and efficacy. However, some recent studies have dispelled this myth, showing successful delivery of dry powders through the humidified circuit of respiratory supports. Compared with other aerosol delivery devices, the use of DPIs during respiratory supports possesses unique advantages such as rapid delivery and high dose. In this review, we presented in vitro studies showing various setups employing commercial DPIs and effects of ventilator parameters on the aerosol delivery. Inclusion of novel DPIs was also made to illustrate characteristics of an ideal inhaler that would give high lung dose with low powder deposition loss in tracheal tubes and respiratory circuits. Clinical trials are urgently needed to confirm the benefits of administration of dry powders in ventilated patients, thus enabling translation of powder delivery into practice.

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“…The inhaled dose increased as the volume of the spacer/adapter increased, with a minimum volume requirement of 150 mL [24,29,[42][43][44][45][46][47]. Among different placements, the inhaled dose was highest with the pMDI and spacer placed in the inspiratory limb 15 cm from the Y-piece [18,48]. pMDI needs to be actuated with the onset of inspiratory flow from the ventilator, the inhaled dose was significantly reduced if the pMDI was actuated during exhalation [24,49].…”

Section: The Use Of Pmdi and Spacermentioning

confidence: 99%

Aerosol therapy in adult critically ill patients: a consensus statement regarding aerosol administration strategies during various modes of respiratory support

Li,

Liu,

Lyu

et al. 2023

Ann. Intensive Care

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Background Clinical practice of aerosol delivery in conjunction with respiratory support devices for critically ill adult patients remains a topic of controversy due to the complexity of the clinical scenarios and limited clinical evidence. Objectives To reach a consensus for guiding the clinical practice of aerosol delivery in patients receiving respiratory support (invasive and noninvasive) and identifying areas for future research. Methods A modified Delphi method was adopted to achieve a consensus on technical aspects of aerosol delivery for adult critically ill patients receiving various forms of respiratory support, including mechanical ventilation, noninvasive ventilation, and high-flow nasal cannula. A thorough search and review of the literature were conducted, and 17 international participants with considerable research involvement and publications on aerosol therapy, comprised a multi-professional panel that evaluated the evidence, reviewed, revised, and voted on recommendations to establish this consensus. Results We present a comprehensive document with 20 statements, reviewing the evidence, efficacy, and safety of delivering inhaled agents to adults needing respiratory support, and providing guidance for healthcare workers. Most recommendations were based on in-vitro or experimental studies (low-level evidence), emphasizing the need for randomized clinical trials. The panel reached a consensus after 3 rounds anonymous questionnaires and 2 online meetings. Conclusions We offer a multinational expert consensus that provides guidance on the optimal aerosol delivery techniques for patients receiving respiratory support in various real-world clinical scenarios.

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In Vitro Evaluation of Aerosol Performance and Delivery Efficiency During Mechanical Ventilation Between Soft Mist Inhaler and Pressurized Metered-Dose Inhaler

Cited by 12 publications

References 32 publications

Optimal Connection for Tiotropium SMI Delivery through Mechanical Ventilation: An In Vitro Study

Optimal Connection for Tiotropium SMI Delivery through Mechanical Ventilation: An In Vitro Study

Administration of dry powders during respiratory supports

Aerosol therapy in adult critically ill patients: a consensus statement regarding aerosol administration strategies during various modes of respiratory support

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