Effect of Nebulizer Location and Spontaneous Breathing on Aerosol Delivery During Airway Pressure Release Ventilation in Bench Testing.
J Aerosol Med Pulm Drug Deliv
; 32(1): 34-39, 2019 02.
Article
em En
| MEDLINE
| ID: mdl-30199313
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Respiração
/
Nebulizadores e Vaporizadores
/
Broncodilatadores
/
Pressão Positiva Contínua nas Vias Aéreas
/
Albuterol
/
Pulmão
Tipo de estudo:
Prognostic_studies
Limite:
Humans
Idioma:
En
Revista:
J Aerosol Med Pulm Drug Deliv
Assunto da revista:
TERAPIA POR MEDICAMENTOS
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
China