TY - JOUR
T1 - Effect of Interrupting Heated Humidification on Nebulized Drug Delivery Efficiency, Temperature, and Absolute Humidity During Mechanical Ventilation
T2 - A Multi-Lab In Vitro Study
AU - Jacquier, Sophie
AU - Lin, HL
AU - Li, Jie
AU - Sheridan, Caylie A.
AU - Karabelas, Paul
AU - Liu, Jui-Fang
AU - Ehrmann, Stephan
AU - Fink, James B.
N1 - Publisher Copyright:
Copyright 2024, Mary Ann Liebert, Inc., publishers
PY - 2024/6/1
Y1 - 2024/6/1
N2 - Introduction: During mechanical ventilation (MV), inspired gases require heat and humidification. However, such conditions may be associated with reduced aerosol delivery efficiency. The practice of turning off heated humidification before nebulization and the impact of nebulization on humidity in a dry ventilator circuit remain topics of debate. This study aimed to assess the effect of turning off heated humidification on inhaled dose and humidity with nebulizer use during adult MV. Methods: A bronchodilator (albuterol) and two antibiotics (Colistimethate sodium and Amikacin sulfate) were nebulized with a vibrating mesh nebulizer placed at the humidifier inlet and in the inspiratory limb at the Y-piece. Additionally, albuterol was nebulized using a jet nebulizer in both placements. Aerosol particle size distribution was determined through a cascade impactor. Absolute humidity (AH) and temperature of inspired gases were determined with anemometer/hygrometers before, during, and after nebulization, before, during, and up to 60 minutes after interrupting active humidification. Aerosol collected on a filter distal to the endotracheal tube and on impactor stages were eluted and assayed by spectrophotometry. Results: The inhaled dose was greater when both nebulizers were placed at the humidifier inlet than the inspiratory limb at the Y-piece. Irrespective of the nebulizer types and placements, the inhaled dose either decreased or showed no significant change after the humidifier was turned off. The aerosol particle size ranged from 1.1 to 2.7 μm. With interruption of active humidification, humidity of inspired gas quickly dropped below recommended levels, and nebulization in dry ventilator circuit produced an AH between 10 and 20 mgH
2O/L, lower than the recommended minimum of 30 mgH
2O/L. Conclusion: Interrupting active humidification during MV before nebulization did not improve aerosol delivery efficiency for bronchodilator or antibiotics, but did reduce humidity below recommended levels.
AB - Introduction: During mechanical ventilation (MV), inspired gases require heat and humidification. However, such conditions may be associated with reduced aerosol delivery efficiency. The practice of turning off heated humidification before nebulization and the impact of nebulization on humidity in a dry ventilator circuit remain topics of debate. This study aimed to assess the effect of turning off heated humidification on inhaled dose and humidity with nebulizer use during adult MV. Methods: A bronchodilator (albuterol) and two antibiotics (Colistimethate sodium and Amikacin sulfate) were nebulized with a vibrating mesh nebulizer placed at the humidifier inlet and in the inspiratory limb at the Y-piece. Additionally, albuterol was nebulized using a jet nebulizer in both placements. Aerosol particle size distribution was determined through a cascade impactor. Absolute humidity (AH) and temperature of inspired gases were determined with anemometer/hygrometers before, during, and after nebulization, before, during, and up to 60 minutes after interrupting active humidification. Aerosol collected on a filter distal to the endotracheal tube and on impactor stages were eluted and assayed by spectrophotometry. Results: The inhaled dose was greater when both nebulizers were placed at the humidifier inlet than the inspiratory limb at the Y-piece. Irrespective of the nebulizer types and placements, the inhaled dose either decreased or showed no significant change after the humidifier was turned off. The aerosol particle size ranged from 1.1 to 2.7 μm. With interruption of active humidification, humidity of inspired gas quickly dropped below recommended levels, and nebulization in dry ventilator circuit produced an AH between 10 and 20 mgH
2O/L, lower than the recommended minimum of 30 mgH
2O/L. Conclusion: Interrupting active humidification during MV before nebulization did not improve aerosol delivery efficiency for bronchodilator or antibiotics, but did reduce humidity below recommended levels.
KW - aerosol
KW - heated humidifier
KW - humidification
KW - jet nebulizer
KW - mechanical ventilation
KW - vibrating-mesh nebulizer
KW - Temperature
KW - Anti-Bacterial Agents/administration & dosage
KW - Humans
KW - Administration, Inhalation
KW - Hot Temperature
KW - Equipment Design
KW - Respiration, Artificial
KW - Amikacin/administration & dosage
KW - Drug Delivery Systems
KW - Colistin/administration & dosage
KW - Particle Size
KW - Time Factors
KW - Humidity
KW - Aerosols
KW - Humidifiers
KW - Albuterol/administration & dosage
KW - Bronchodilator Agents/administration & dosage
KW - Nebulizers and Vaporizers
UR - http://www.scopus.com/inward/record.url?scp=85189903460&partnerID=8YFLogxK
U2 - 10.1089/jamp.2023.0028
DO - 10.1089/jamp.2023.0028
M3 - Journal Article
C2 - 38563793
SN - 1941-2711
VL - 37
SP - 115
EP - 124
JO - Journal of Aerosol Medicine and Pulmonary Drug Delivery
JF - Journal of Aerosol Medicine and Pulmonary Drug Delivery
IS - 3
ER -