Respiratory Care |

Quantifying Aerosol Delivery in Spontaneously Breathing Patients With Tracheostomy Using Different Humidification Systems With or Without Exhaled Humidity FREE TO VIEW

Arzu Ari, PhD; James Fink, PhD
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Georgia State University, Atlanta, GA

Chest. 2014;145(3_MeetingAbstracts):539A. doi:10.1378/chest.1814962
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SESSION TITLE: Respiratory Support Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Aerosol and humidification therapy are used in long-term airway management of critically ill patients with tracheostomy. The purpose of this study was to determine delivery efficiency of jet (JN) and mesh (MN) nebulizers combined with various humidification systems in a spontaneously breathing adult lung model with tracheostomy with or without exhaled humidity.

METHODS: An in-vitro model was constructed to simulate spontaneously breathing adults (Vt: 400 mL, RR:20 bpm, and I:E ratio 1:2) with tracheostomy using a teaching manikin attached to a test lung through a collecting filter (Respirgard II, Vital Signs). Exhaled heat and humidity was simulated using a cascade humidifier set to deliver 37 °C and >95% relative humidity. Albuterol sulfate (2.5mg/3mL) was administered through JN (Misty Max, Airlife) and MN (Aeroneb Solo, Aerogen) using heated humidifier (HH), unheated large volume humidifier (LVH) at 40 lpm output and heat-moisture exchanger (HME). Inhaled drug was collected on a filter during each experiment and analyzed via spectrophotometry (276 nm).

RESULTS: Percentage of dose (mean ± SD ) delivered distal to the trachea with JN (from 1.4 to 6.6%) and was less than MN ( 2.1 - 17.7%) under all conditions (p<0.05). Independent of nebulizer used, delivery was greatest in room air and lowest when HH with higher flows. Exhaled humidity decreased drug delivery up to 40%.

CONCLUSIONS: Use of supplemental gas flow during aerosol can reduce inhaled dose with both JN and MN. This model simulating exhaled humidity demonstrated a reduction in drug delivery compared to models with nonheated/humidified exhalation.

CLINICAL IMPLICATIONS: Selection of aerosol devices for use with various HH, LVH and HMEs can make up to 10 fold difference in inhaled medical aerosols. Models that do not simulate exhaled humidity may over estimate delivered dose up to 40%.

DISCLOSURE: James Fink: Consultant fee, speaker bureau, advisory committee, etc.: Aerogen, Bayer, Boerhinger Ingleheim, Cubist, Dance Biopharm, Novartis, ONY, Parion, Aridis, and the WHO The following authors have nothing to disclose: Arzu Ari

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