Effect of Nebulizer Location and Spontaneous Breathing on Aerosol Delivery During Airway Pressure Release Ventilation in Bench Testing

Hui-Qing Ge; Ji-Mei Wang; Hui-Ling Lin; James B Fink; Ronghua Luo; Peifeng Xu; Kejing Ying

doi:10.1089/jamp.2018.1457

Effect of Nebulizer Location and Spontaneous Breathing on Aerosol Delivery During Airway Pressure Release Ventilation in Bench Testing

J Aerosol Med Pulm Drug Deliv. 2019 Feb;32(1):34-39. doi: 10.1089/jamp.2018.1457. Epub 2018 Sep 8.

Authors

Hui-Qing Ge¹, Ji-Mei Wang¹, Hui-Ling Lin², James B Fink³, Ronghua Luo⁴, Peifeng Xu¹, Kejing Ying⁵

Affiliations

¹ 1 Department of Respiratory Care, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
² 2 Department of Respiratory Care, Chang Gung University, Taoyuan City, Taiwan.
³ 3 Aerogen Pharma Corp., San Mateo, California.
⁴ 4 Department of Cardiology, Hangzhou Red Cross Hospital, Hangzhou, China.
⁵ 5 Department of Pulmonary Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.

PMID: 30199313
DOI: 10.1089/jamp.2018.1457

Abstract

Background: Airway pressure release ventilation (APRV) maintains a sustained airway pressure over a large proportion of the respiratory cycle, and has a long inspiratory time at high pressure. The purpose of this study was to determine the influence of the APRV with and without spontaneous breathing on albuterol aerosol delivery with a continuous vibrating-mesh nebulizer (VMN) placed at different positions on an adult lung model of invasive mechanical ventilation.

Methods: An adult lung model was assembled by connecting a ventilator with a dual-limb circuit to an 8-mm inner diameter endotracheal tube (ETT) and collecting filter attached to a test lung with set compliance of 0.1 L/cmH₂O and resistance of 0.5 cmH₂O/(L·s). Four ventilator modes were compared: pressure control ventilation (PCV) with no bias flow, PCV with bias flow of 6 L/min (PCV_BF6), APRV with no spontaneous breaths (APRV), and APRV with spontaneous breath trigger (APRVs). Peak inspiratory pressure, peak end-expiratory pressure, aerosol dose, and nebulization time were similar for all modes. The VMN was placed (1) between Y-piece and inspiratory limb, (2) at the gas outlet of a heated humidifier, and (3) at the gas inlet of a heated humidifier. Albuterol sulfate (5 mg/2.5 mL) was administered with each run and collected on a filter distal to the ETT. Deposited drug was eluted from each filter (purified water) and analyzed by UV spectrophotometry at 276 nm. Analysis of variance [general linear model (GLM) multivariate] was performed using the linear model of multiple variables, significance at p < 0.05.

Results: Albuterol (in micrograms, mean ± standard deviation) delivered was higher with VMN placed at the gas inlet of the humidifier with each mode of ventilation (p < 0.01). APRVs has the highest albuterol delivery followed by PCV, PCV_BF6, and APRV (1706.2 ± 60.9 μg vs. 1490.6 ± 61.1 μg vs. 1182.3 ± 61.4 μg vs. 1153.1 ± 99.7 μg, respectively, p < 0.001). The minute volume was positively correlated with the inhaled albuterol dose.

Conclusions: Spontaneous breathing increased the albuterol delivery during APRV, compared with APRV alone and PCV modes. Placing the nebulizer proximal to the ventilator was more efficient for all modes tested.

Keywords: aerosol delivery; airway pressure release ventilation; bench testing; spontaneous breath; ventilation mode; vibrating-mesh nebulizer.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Administration, Inhalation
Aerosols
Albuterol / administration & dosage*
Albuterol / chemistry
Bronchodilator Agents / administration & dosage*
Bronchodilator Agents / chemistry
Continuous Positive Airway Pressure*
Drug Compounding
Equipment Design
Humans
Lung / anatomy & histology
Lung / physiology*
Materials Testing
Models, Anatomic
Nebulizers and Vaporizers*
Respiration*

Substances

Aerosols
Bronchodilator Agents
Albuterol