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Salbutamol Delivery From a Hydrofluoroalkane Pressurized Metered-Dose Inhaler in Pediatric Ventilator Circuits : An In Vitro Study

Johannes H. Wildhaber; Nigel D. Dore; Sunalene G. Devadason; Peter N. LeSouëf; Mark J. Hayden
Author and Funding Information

Affiliations: From the Perth Medical Aerosol Research Group, Departments of Respiratory Medicine, Princess Margeret Hospital for Children, Subiaco, Western, Australia,  From the Intensive Care, Princess Margeret Hospital for Children, Subiaco, Western, Australia

Affiliations: From the Perth Medical Aerosol Research Group, Departments of Respiratory Medicine, Princess Margeret Hospital for Children, Subiaco, Western, Australia,  From the Intensive Care, Princess Margeret Hospital for Children, Subiaco, Western, Australia


1998 by the American College of Chest Physicians


Chest. 1998;113(1):186-191. doi:10.1378/chest.113.1.186
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Abstract

Study objectives: The aim of our study was to determine the in vitro delivery of salbutamol from a pressurized metered-dose inhaler (pMDI) containing hydrofluoroalkane (HFA) propellant through various delivery devices to four models of a pediatric lung.

Design: To determine the effect of electrostatic charge, delivery of salbutamol was initially assessed with a multistage liquid impinger (MSLI) through an inline nonchamber device (Baxter MDI Adapter) and a small (Aerochamber MV) and a large (Nebuhaler) inline chamber device. Following this, the delivery was assessed to four lung models appropriate for a child of 70 kg, 50 kg, 15 kg, and 4 kg, with the same three reduced static devices inserted directly into a pediatric ventilator circuit.

Measurements and results: Reduction of electrostatic charge improved small particle delivery through holding chambers to the MSLI by 12 to 14%. In the ventilator model, the mean delivery was between 1.9% and 5.4% for the nonchamber device, between 14.3% and 27.2% for the small holding chamber, and between 7.2% and 25.7% for the large holding chamber. Delivery was the least efficient in the 4-kg model compared to the 70-kg, 50-kg, and 15-kg models.

Conclusions: Salbutamol from an HFA pMDI is delivered efficiently through inline holding chambers with reduced static in pediatric ventilator settings. A large holding chamber has no advantage over a small holding chamber. In addition, salbutamol delivery is more efficient through a holding chamber than through a nonchamber device.


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