Aerosolized Drugs Deposition Delivered through a Mechanical Ventilator and the Optimal Aerosol Delivery

Aerosolized drugs can be absorbed by the epithelium of the airways and alveolar, and then produces a rapid onset of pharmaceutical actions. Drug doses for aerosol delivery are usually smaller than those for systemic treatment, thus fewer and less severe adverse effects are seen. Aerosolized medications including bronchodilators, steroids, mucolytics, and antibiotics are used widely to patients with respiratory illness and patients under mechanical ventilation. Aerosol delivery through a mechanical ventilator is influenced by numerous factors from ventilator-related, circuit-related to device-related factors. Aerosolized drugs delivery through a ventilator system is commonly studied on bench model with albuterol, yet the results are often overestimated. Only a few clinical trials on aerosol delivery depositions were published in the last two decades. In addition, inhaled bronchodilators, mucolytics, antibiotics, and steroids are often administered to ventilated patients in the intensive care units in Taiwan, but they have never been further investigated. Therefore, we proposed a three year research project. In the first year we will establish analytical methods for aerosolized drugs employed clinically in Taiwan. Drugs will be delivered by a small volume nebulizer or a vibrating mesh nebulizer placed after the Y-adaptor of a ventilator inspiratory circuit or at the outlet of a heated humidifier chamber in a ventilator system. Aerosol deposition on inhaled /exhaled filters and particle size distributions will be collected and analyzed. In the second year we will evaluate inhaled bronchodilators (salbutamol, terbutaline, ipratropium bromide, and combivent) delivered by two nebulizers placed after the Y-adaptor of a ventilator circuit or at the outlet of a heated humidifier in a ventilator system to intubated patients. To compare drug delivery efficiency and the environmental exposure, the inhaled drug mass and exhaled drug mass will be collected and analyzed. In the third year we will evaluate inhaled antibiotics (gentamycin and colistine), mucolytics (acytylcystine), and steroids (budesonide) delivered by two nebulizers placed after the Y-adaptor of a ventilator circuit or at the outlet of a heated humidifier in a ventilator system on intubated patients. The inhaled drug mass and exhaled drug mass will be sampled. The results will help us as clinicians to establish an optimal aerosolized drug delivery protocol for better therapeutic outcome, and the correlation between in vitro and in vivo will guide clinicians for future inhaled drug dose estimation and the environmental protection during aerosol therapy.

Project ID:PC10408-2486
External Project ID:MOST104-2314-B182-025