Workshop Report: Aerosol Delivery to Spontaneously Breathing Tracheostomized Patients

Berlinski, Ariel; Ari, Arzu; Davies, Phil; Fink, Jim; Majaesic, Carina; Reychler, Grégory; Tatla, Taran; Amirav, Israel

doi:10.1089/jamp.2016.1348

Cited by 6 publications

(6 citation statements)

References 44 publications

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“…Manual resuscitators can be used for aerosol delivery to achieve spontaneous breathing in tracheostomized children [15,16]. This method of drug administration could be employed when doses of bronchodilators need to be rapidly administered to a patient with an artificial airway [17].…”

Section: Manual Resuscitation Bag Delivery Techniquementioning

confidence: 99%

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: Manual Resuscitation Bag Delivery Techniquementioning

confidence: 99%

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

et al. 2020

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“…Особенности образования и доставки аэрозоля позволяют использовать небулайзеры не только для лечения бронхообструктивных заболеваний или заболеваний верхних дыхательных путей. Различные состояния, требующие интенсивной терапии, могут потребовать ингаляционного введения препаратов, включая ситуации, когда пациент находится на искусственной вентиляции легких или ему установлена трахеостома [18][19][20][21]. Так, у взрослых и новорожденных в комплексной терапии острого респираторного дистресс-синдрома (ОРДС), развивающегося вследствие прямого или непрямого повреждения легких и сопровождающегося высоким уровнем летальности, наряду с протективной вентиляционной поддержкой и парентеральным введением препаратов, могут ингаляционно применяться сурфактант, бронходилататоры [22,23].…”

Section: клиническое применение небулайзеровunclassified

Рossibilities of clinical application of modern nebulizers

Белоцерковская

2020

Medicinskij sovet

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The simplicity of converting medicinal solutions and suspensions into aerosols using mechanical and thermal energy, convenient delivery to the airways allows nebulizers to take a worthy place in the treatment of hospitalized and outpatient patients. Different types of nebulizers are available for use in the home and in medical settings (jet, ultrasound, membrane), and researches show that the performance and characteristics of the aerosol vary between different devices and manufacturers. Jet nebulizers are still the most used devices that do not require coordination of inhale and delivery of aerosol to the respiratory tract. To reduce the consumption of medicinal aerosol and optimize the air flow, virtual valve technology (V.V.T.) is being improved, and breath-actuated nebulizers are being created. The advantage of nebulizer therapy is the ability to apply large doses of medications, use substances that exist only in inhaled form. The choice falls on the nebulizer in cases where the patient can not use other delivery devices, for example, if the patient is unable to coordinate the inhalation and intake of the drug into the respiratory tract, with a severe exacerbation of obstructive disease, in the presence of motor disorders. The optimal delivery device for children of any age, including newborns, is a nebulizer. The most common indication for nebulizer therapy is the delivery of bronchodilators and inhaled corticosteroids for asthma or chronic obstructive pulmonary disease, as well as the treatment of upper respiratory tract diseases, in particular croup in children. An important place is given to nebulizers when it is necessary to prescribe certain mucolytics and antibiotics. In the treatment of emergency conditions, inhalation administration of drugs may be required, including situations when the patient is on mechanical ventilation or has a tracheostomy installed. The significance of nebulizers in the treatment of cystic fibrosis, pulmonary arterial hypertension, and alpha-1-antitrypsin deficiency is being studied. The possibilities of endobronchial delivery of heparin, insulin, and monoclonal antibodies are evaluated.

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“…10 A structured search in the literature identified a lack of studies in this area. Cooper and Berlinski (2017) 11 evaluated the aerosol delivery using a child lung simulation model with spontaneous breathing patterns. They compared the effect on the drug delivery when pMDI was triggered by the oral cavity with a spacer and mask and when triggered by tracheostomy through a spacer designed specifically for adaptation to the cannula.…”

Section: Rbfhssmentioning

confidence: 99%

Administration of inhaled medications during noninvasive ventilation and/or tracheostomy

Asturian¹,

Ferreira²

2020

Rev Bras Farm Hosp Serv Saude

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Objectives: To describe the clinical and demographic profile of hospitalized patients undergoing noinvasive ventilation (NIV) and/or tracheostomy (TQT) with prescription of the pressurized inhaler (pMDI) and the difficulties and interventions performed to adapt the inhalation technique. Methods: This is an observational, retrospective and descriptive study of a series of cases, carried out in three clinical units of a university hospital in the years 2017 and 2018. Results: We analyzed data from 25 patients who received NIV and/or TQT for whom guidance has been requested from the Inhalation Techniques Guidance and Training Group (GOTTI). Of these, 15 patients (60%) were using NIV, 5 (20%) were tracheostomized and 5 (20%) were tracheostomized with NIV. The difficulties identified in these patients were insecurity in removing the support, preference for nebulization, adaptation of the pMDI to the cannula and asynchrony between the jet firing and the beginning of inspiration. Conclusions: The use of aero-chamber coupled to the pMDI and tidal volume were the mostly made interventions. Masks and guidelines on the access route to the ventilation system were adapted in most cases This group of patients has particularities and difficulties in the inhalation technique that justify a specific educational intervention by professionals with more in-depth knowledge in the area.

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Workshop Report: Aerosol Delivery to Spontaneously Breathing Tracheostomized Patients

Cited by 6 publications

References 44 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

Рossibilities of clinical application of modern nebulizers

Administration of inhaled medications during noninvasive ventilation and/or tracheostomy

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