Inhaled salbutamol dose delivered by jet nebulizer, vibrating mesh nebulizer and metered dose inhaler with spacer during invasive mechanical ventilation

Muhammad H E ElHansy; Marina E Boules; Assem Fouad Mohamed El Essawy; Mohamed Bakry Al-Kholy; Maha M Abdelrahman; Amira S A Said; Raghda R S Hussein; Mohamed E Abdelrahim

doi:10.1016/j.pupt.2017.06.004

Inhaled salbutamol dose delivered by jet nebulizer, vibrating mesh nebulizer and metered dose inhaler with spacer during invasive mechanical ventilation

Pulm Pharmacol Ther. 2017 Aug:45:159-163. doi: 10.1016/j.pupt.2017.06.004. Epub 2017 Jun 13.

Authors

Muhammad H E ElHansy¹, Marina E Boules², Assem Fouad Mohamed El Essawy³, Mohamed Bakry Al-Kholy⁴, Maha M Abdelrahman⁵, Amira S A Said², Raghda R S Hussein², Mohamed E Abdelrahim⁶

Affiliations

¹ Clinical Pharmacy Department, Teaching Hospital of Faculty of Medicine, Faculty of Medicine, Fayoum University, Fayoum, Egypt.
² Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt.
³ Department of Chest Diseases, Faculty of Medicine, Cairo University, Cairo, Egypt.
⁴ Critical Care Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.
⁵ Analytical Chemistry Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt.
⁶ Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt; Clinical Pharmacy Department, Faculty of Pharmacy, Ahram Canadian University, Giza, Egypt. Electronic address: mohamedemam9@yahoo.com.

PMID: 28627376
DOI: 10.1016/j.pupt.2017.06.004

Abstract

Background: Patient receiving invasive mechanical ventilation (IMV) may benefit from medical aerosol, but guidance on dosing with different aerosol devices is limited to in-vitro studies. The study was designed to compare aerosol delivery with five different types of aerosol generators during IMV.

Method: In randomized design, 60 (30 female) mechanically ventilated chronic obstructive pulmonary disease (COPD) patients were assigned to one of 5 groups. Groups 1-4 received 5000 μg salbutamol using Aerogen Pro (PRO), Aerogen Solo (SOLO), NIVO vibrating mesh and jet nebulizers (JN), respectively, while group 5 received 800 μg (8 puffs) of salbutamol via metered dose inhaler with AeroChamber-MV (MDI-AC). All devices were place in the inspiratory limb of ventilator downstream from humidifier which was switched off while delivery. Patients received the inhaled dose on day 1 and provided urine 30 post dosing. They also recived the same inhaled dose with a filter before the endotracheal tube on day 2. Amount of salbutamol excreted in urine 30 min post inhalation and the amount deposited on the filter from all the COPD patients were determined as indeces of pulmonary deposition and systemic absorption, respectively.

Results: No significant difference was found between the 3 vibrating mesh nebulizers (VMNs). The in-vivo and ex-vivo testing showed that all the VMNs resulted in better aerosol delivery compared to JN (p < 0.01). However, MDI-AC resulted in better aerosol delivery to VMNs but must be accompanied with careful attention and proper delivery of MDI-AC doses by healthcare provider.

Conclusions: VMNs can be exchanged with each other, with no dose adjustment. However, dose adjustment is a must when replacing VMNs by JN or MDI-AC. This similarity and difference between the 5 aerosol delivery methods suggest that for IMV patients, aerosol delivery methods should be chosen or substituted with care.

Keywords: Comparison; Invasive ventilation; Nebulizer; Spacer; Urinary salbutamol.

Publication types

Comparative Study
Randomized Controlled Trial

MeSH terms

Administration, Inhalation
Aerosols
Aged
Aged, 80 and over
Albuterol / administration & dosage*
Bronchodilator Agents / administration & dosage*
Dose-Response Relationship, Drug
Female
Humans
Inhalation Spacers
Male
Metered Dose Inhalers
Middle Aged
Nebulizers and Vaporizers
Pulmonary Disease, Chronic Obstructive / therapy*
Respiration, Artificial / methods*

Substances

Aerosols
Bronchodilator Agents
Albuterol