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Effect of Nebulizer Location and Spontaneous Breathing on Aerosol Delivery During Airway Pressure Release Ventilation in Bench Testing.
- Source :
-
Journal of Aerosol Medicine & Pulmonary Drug Delivery . Feb2019, Vol. 32 Issue 1, p34-39. 6p. - Publication Year :
- 2019
-
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 (PCVBF6), 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, PCVBF6, 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. [ABSTRACT FROM AUTHOR]
- Subjects :
- *ULTRAVIOLET spectrophotometry
*ATOMIZERS
*AEROSOLS
*HUMIDIFIERS
Subjects
Details
- Language :
- English
- ISSN :
- 19412711
- Volume :
- 32
- Issue :
- 1
- Database :
- Academic Search Index
- Journal :
- Journal of Aerosol Medicine & Pulmonary Drug Delivery
- Publication Type :
- Academic Journal
- Accession number :
- 134353703
- Full Text :
- https://doi.org/10.1089/jamp.2018.1457