The Effects of Inspiratory Flows, Inspiratory Pause, and Suction Catheter on Aerosol Drug Delivery with Vibrating Mesh Nebulizers During Mechanical Ventilation

HL Lin, James B Fink, Jie Li

Research output: Contribution to journalJournal Article peer-review

1 Scopus citations

Abstract

Background: Some experts recommend specific ventilator settings during nebulization for mechanically ventilated patients, such as inspiratory pause, high inspiratory to expiratory ratio, and so on. However, it is unclear whether those settings improve aerosol delivery. Thus, we aimed to evaluate the impact of ventilator settings on aerosol delivery during mechanical ventilation (MV). Methods: Salbutamol (5.0 mg/2.5 mL) was nebulized by a vibrating mesh nebulizer (VMN) in an adult MV model. VMN was placed at the inlet of humidifier and 15 cm away from the Y-piece of the inspiratory limb. Eight scenarios with different ventilator settings were compared with endotracheal tube (ETT) connecting 15 cm from the Y-piece, including tidal volumes of 6-8 mL/kg, respiratory rates of 12-20 breaths/min, inspiratory time of 1.0-2.5 seconds, inspiratory pause of 0-0.3 seconds, and bias flow of 3.5 L/min. In-line suction catheter was utilized in two scenarios. Delivered drug distal to the ETT was collected by a filter, and drug was assayed by an ultraviolet spectrophotometry (276 nm). Results: Compared to the use of inspiratory pause, the inhaled dose without inspiratory pause was either higher or similar across all ventilation settings. Inhaled dose was negatively correlated with inspiratory flow with VMN placed at 15 cm away from the Y-piece ( r s  = -0.68, p  < 0.001) and at the inlet of humidifier ( r s  = -0.83, p  < 0.001). The utilization of in-line suction catheter reduced inhaled dose, regardless of the ventilator settings and nebulizer placements. Conclusions: When VMN was placed at the inlet of humidifier, directly connecting the Y-piece to ETT without a suction catheter improved aerosol delivery. In this configuration, the inhaled dose increased as the inspiratory flow decreased, inspiratory pause had either no or a negative impact on aerosol delivery. The inhaled dose was greater with VMN placed at the inlet of humidifier than 15 cm away the Y-piece.

Original languageAmerican English
Pages (from-to)125-131
Number of pages7
JournalJournal of Aerosol Medicine and Pulmonary Drug Delivery
Volume37
Issue number3
Early online date01 04 2024
DOIs
StatePublished - 01 06 2024

Bibliographical note

Publisher Copyright:
Copyright 2024, Mary Ann Liebert, Inc., publishers

Keywords

  • in-line suction catheter
  • inspiratory flow
  • inspiratory pause
  • mechanical ventilation
  • nebulization
  • vibrating mesh nebulizer
  • Suction
  • Vibration
  • Humans
  • Administration, Inhalation
  • Tidal Volume
  • Equipment Design
  • Catheters
  • Intubation, Intratracheal/instrumentation
  • Inhalation
  • Time Factors
  • Respiration, Artificial/instrumentation
  • Aerosols
  • Adult
  • Albuterol/administration & dosage
  • Bronchodilator Agents/administration & dosage
  • Nebulizers and Vaporizers
  • Drug Delivery Systems/instrumentation

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