In Vitro Evaluation of Radio-Labeled Aerosol Delivery Via a Variable-Flow Infant CPAP System

Farney, Kimberly D; Kuehne, Brandon; Gibson, Laurie A; Nelin, Leif D.; Shepherd, Edward G.

doi:10.4187/respcare.01904

Cited by 9 publications

(8 citation statements)

References 15 publications

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“…The positional differences noted in the present study are also similar to findings of Farney et al, 25 who evaluated radiolabeled aerosol delivery with a VMN to an infant test lung during continuous positive airway pressure and found that placing the VMN proximal to the patient airway resulted in significantly greater drug delivery than when placed back at the humidifier. Multiple investigators have described the impact of placement of a VMN in distal and proximal positions during simulated pediatric [19][20][21] and adult 18 mechanical ventilation.…”

Section: Discussionsupporting

confidence: 90%

Iloprost Drug Delivery during Infant Conventional and High‐Frequency Oscillatory Ventilation

et al. 2016

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Iloprost is a selective pulmonary vasodilator approved for inhalation by the Food and Drug Administration. Iloprost has been increasingly used in the management of critically ill neonates with hypoxic lung disease. This in vitro study was designed to test the hypothesis that aerosol drug delivery could be effectively administered to infants with both conventional ventilation and high-frequency oscillatory ventilation (HFOV). A neonatal test lung model configured with newborn lung mechanics was ventilated with a conventional ventilator and an HFOV with standard settings. A vibrating-mesh nebulizer was placed (1) proximal to the patient airway in the inspiratory limb between the humidifier probe and patient wye (conventional) as well as between the vent circuit and the endotracheal tube (ETT) for HFOV and (2) between the ventilator and humidifier (distal). Iloprost was nebulized in three separate runs using three new nebulizers in each of the circuit locations. A collecting filter was placed at the distal end of the ETT for each trial. Iloprost was quantified using highperformance liquid chromatography. The percentage of nominal dose delivered was greater with the nebulizer placed proximal to the airway for conventional ventilation (10.74% ± 2%) and HFOV (29% ± 2%) than with it placed in the distal position (2.96% ± 0.2% vs. 0.96% ± 0.8%, respectively; P < 0.05). Drug delivery in proximal position was nearly threefold greater during HFOV than during conventional ventilation. In conclusion, iloprost drug delivery was best achieved when the nebulizer was placed proximal to the patient airway during neonatal mechanical ventilation. Drug delivery appears to be more efficient during HFOV than during conventional ventilation.Keywords: neonatal ventilation, pediatric aerosol delivery, high-frequency ventilation, inhaled pulmonary vasodilation, infant hypoxic lung disease. Iloprost (Ventavis; Actelion Pharmaceuticals US) is a stable prostacyclin analog used in the treatment of pulmonary hypertension. It is pharmacologically similar to epoprostenol, with vasodilatory, vascular remodeling, and platelet inhibitory properties, but it is a more stable compound, with an elimination half-life of 20-30 minutes. 1The longer half-life than that of other prostacyclin formulations allows the drug to be delivered with less frequency. Iloprost was the first prostacyclin designed specifically for aerosolization and approved for inhalation in ambulatory adults with primary pulmonary hypertension using the I-neb AAD system (Philips Respironics, Netherlands), a vibrating-mesh smart nebulizer. The design of the I-neb precludes its use in a closed ventilator circuit. While researchers have described a strategy for aerosol delivery during adult mechanical ventilation, none have applied such strategies for use with iloprost in infants. 2 Iloprost inhalation has been reported to be of some benefit in the management of critically ill neonates and infants with hypoxic lung disease and pulmonary hypertension.3-17 Many neonates with sever...

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Section: Discussionsupporting

confidence: 90%

Iloprost Drug Delivery during Infant Conventional and High‐Frequency Oscillatory Ventilation

et al. 2016

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“…Farney et al 81 showed greater delivery of technetium99m-labeled diethylenetriaminepentaacetic acid via a vibrating mesh nebulizer placed 32 cm from nasal CPAP prongs then when placed before the humidifier (21% vs 0.3%) during simulated neonatal CPAP (Infant Flow SiPAP [CPAP setting], CareFusion). Residual impactive aerosol losses were characterized within the delivery pathways between the different nebulizer locations.…”

Section: Noninvasive Respiratory Supportmentioning

confidence: 99%

Clinical Controversies in Aerosol Therapy for Infants and Children

DiBlasi

2015

Respir Care

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Pediatric patients are different from adult patients with respect to airway anatomy and breathing patterns. They are also incapable of following commands and often reject breathing treatments. For these reasons, aerosol drug delivery is one of the most technically challenging aspects for clinicians providing respiratory care to young children. Improvements in nebulizer technology have provided better delivery options for pediatric patients. This review highlights research related to pediatric nebulizer and interface devices and how they can be used to provide the safest and most efficient treatments with the array of treatment delivery options. Also addressed are clinical controversies and debates in pediatric aerosol science, including drug delivery in crying versus resting infants, pressurized metered-dose inhalers and small-volume nebulizers for bronchodilator administration, continuous nebulization, noninvasive drug delivery options, and optimization of nebulizer performance during infant and large pediatric conventional and high-frequency ventilation.

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Section: Delivery To Patients Requiring Mechanical Supportmentioning

confidence: 99%

“…In a slightly different mode of delivery, 2 other studies published in RESPIRATORY CARE 23,24 investigated noninvasive ventilation techniques to administer aerosol therapy. Farney et al 23 hypothesized that aerosol delivery to the lungs via variable-flow nasal CPAP in an in vitro model would be unreliable and would depend on the position of the aerosol generator within the nasal CPAP circuit. The results of this bench study showed that the relative aerosol delivery to the infant test lung with the nebulizer close to the humidifier was extremely low, whereas placing the nebulizer close to the nasal prongs resulted in significantly improved delivery (Fig.…”

Section: Delivery To Patients Requiring Mechanical Supportmentioning

confidence: 99%

Year in Review 2014: Aerosol Delivery Devices

Myers

2015

Respir Care

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After centuries of discoveries and technological growth, aerosol therapy remains a cornerstone of care in the management of both acute and chronic respiratory conditions. Aerosol therapy embraces the concept that medicine is both an art and a science, where an explicit understanding of the science of aerosol therapy, the nuances of the different delivery devices, and the ability to provide accurate and reliable education to patients become increasingly important. The purpose of this article is to review recent literature regarding aerosol delivery devices in a style that readers of Respiratory Care may use as a key topic resource.

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In Vitro Evaluation of Radio-Labeled Aerosol Delivery Via a Variable-Flow Infant CPAP System

Cited by 9 publications

References 15 publications

Iloprost Drug Delivery during Infant Conventional and High‐Frequency Oscillatory Ventilation

Iloprost Drug Delivery during Infant Conventional and High‐Frequency Oscillatory Ventilation

Clinical Controversies in Aerosol Therapy for Infants and Children

Year in Review 2014: Aerosol Delivery Devices

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