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Clinical Investigations: AEROSOLS |

Comparison of Lung Deposition in Two Types of Nebulization*: Intrapulmonary Percussive Ventilation vs Jet Nebulization

Gregory Reychler; André Keyeux; Caroline Cremers; Claude Veriter; Daniel O. Rodenstein; Giuseppe Liistro
Author and Funding Information

*From the Departments of Physical Medicine and Rehabilitation (Ms. Cremers), and Pediatry (Mr. Reychler), Nuclear Medicine (Dr. Keyeux), and Pneumology Unit (Mr. Veriter and Drs. Rodenstein and Liistro), Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.

Correspondence to: Giuseppe Liistro, PhD, Pneumology Unit, Cliniques Universitaires St-Luc (UCL), Avenue Hippocrate 10, 1200 Brussels, Belgium; e-mail: giuseppe.liistro@clin.ucl.ac.be



Chest. 2004;125(2):502-508. doi:10.1378/chest.125.2.502
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Background: So-called intrapulmonary percussive ventilation (IPV), frequently coupled with a nebulizer, is increasingly used as a physiotherapy technique; however, its physiologic and clinical values have not been rigorously assessed.

Study objective: To compare in vitro and in vivo characteristics of the nebulizer of the IPV device (Percussionaire; Percussionaire Corporation; Sandpoint, ID) with those of standard jet nebulization (SST) [SideStream; Medic-Aid; West Sussex, UK].

Design: Aerodynamic particle size was studied by an cascade impactor. The deposition of 99mTc-diethylenetriaminepenta-acetic acid was measured in 10 healthy subjects by tomoscintigraphy during spontaneous breathing with both nebulizers.

Measurements and results: The mass median aerodynamic diameter (0.2 μm vs 1.89 μm for IPV and SST, respectively) and the fine-particle fraction (16.2% vs 67.5%, respectively) were significantly smaller with IPV. In vivo, respiratory frequency (RF) was lower with the IPV device (10.1 ± 3.4 breaths/min vs 14.6 ± 3.4 breaths/min, p = 0.002). Whole-body deposition was significantly higher with IPV (15.63% vs 9.31%), but it was due to a higher extrapulmonary deposition. Although intrapulmonary deposition (IPD) was not different with both devices (4.20% for SST vs 2.49% for IPV), it was much more variable with IPV, compared to SST. The penetration index into the lung was higher with IPV than SST when normalized for RF (0.045 ± 0.018 breaths/min vs 0.026 ± 0.013 breaths/min, p = 0.007).

Conclusion: The two techniques showed comparable lung deposition despite a large difference in particle size. However, IPV IPD was too variable and thus too unpredictable to recommend its use for drug delivery to the lung.

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