SESSION TYPE: Pharmacology in the ICU Posters
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: Delivery of inhaled medications administered with different aerosol devices in patients with tracheostomy tube (TT) has not been described. The purpose of this study was to quantify aerosol drug delivery in simulated adults with TT using the jet nebulizer and pMDI tested with three different types of spacers.
METHODS: An adult manikin’s upper airway was intubated with TT (Portex) of 8 mmID, connected to a collecting filter (Respirgard II) at the trachea and a passive test lung. Albuterol sulfate (2.5 mg/3mL) was administered via a jet nebulizer (eValueMed, Trianim) at 8 lpm O2 and pMDI (ProAir HFA) using Uni-directional (Instrumentation Industries), Bi-directional (Hudson RCI) and Aerovent (Monaghan/Trudell) spacers. Each device was placed between the ambu bag (Smiths Medical) and TT at a rate of 12/min using one hand with pMDI and 2 hands with the jet nebulizer. Drug was eluted from the filter and analyzed with spectrophotometry (276 nm). Data were analyzed with descriptive statistics, one-way ANOVA and paired sample t-test (p<0.05).
RESULTS: Table shows the mean % (± SD) of emitted (pMDI) and nominal (SVN) dose delivered distal to the trachea with each device. Differences among the type of spacers in aerosol delivery with pMDI were statistically significant (p=0.0001). Using ambu bag for aerosol treatment, the pMDI/AeroVent combination delivered more aerosol than other options tested in this study (p=0.001).
CONCLUSIONS: The choice of aerosol delivery options between pMDI using various spacers and the jet nebulizer resulted in > 20 fold difference in tracheal deposition during manual ventilation in this model of tracheotomized adults.
CLINICAL IMPLICATIONS: The wide differences in drug available distal to the trachea with the aerosol delivery systems tested may result in dosing below the therapeutic threshold or exceeding the toxicity threshold for a specific drug. Dosing should be adjusted accordingly.
DISCLOSURE: The following authors have nothing to disclose: Arzu Ari, Robert Harwood, Meryl Sheard, James Fink
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