Aerosol delivery in models of pediatric high flow nasal oxygen and mechanical ventilation

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Aerosol drug delivery during high flow nasal oxygen (HFNO) and invasive mechanical ventilation (IMV) are key respiratory care strategies available for the treatment of pediatric patients. We aimed to quantify the impact of different HFNO and IMV set‐ups on tracheal drug delivery via a vibrating mesh nebuliser (VMN).

Methods

Percent tracheal dose via VMN was quantified during HFNO therapy and IMV in a benchtop model of a 9‐month‐old infant. Under HFNO, 3 cannula sizes were used at 3 flow rate settings with the VMN placed at the dry side of the humidifier. Under IMV, tracheal dose when VMN was placed at the dry side of the humidifier, 15 cm from the wye and between the wye and endotracheal tube (ETT) was assessed. Salbutamol at 2.5 mg/2.5 ml (1 mg/ml) was used for each test ( N = 5). The impact of VMN refill on circuit pressure under HFNO and IMV was also assessed.

Results

Tracheal dose was highest during HFNO with the largest cannula size (OPT318) set to the lowest flow rate setting of 2 L/min (liter per minute) (5.80 ± 0.17%). Increasing flow rate reduced tracheal drug delivery for all cannulas. For IMV, VMN on the dry side of the humidifier and between the wye and ETT gave optimal drug delivery (4.49 ± 0.14% vs. 4.43 ± 0.26% respectively). VMN refill did not impact circuit pressure for either HFNO therapy or IMV.

Conclusions

Gas flow rate and cannula size during HFNO and VMN position during IMV has a significant effect on tracheal drug delivery in a pediatric setting.

Related collections

Most cited references 37

Record: found
Abstract: found
Article: not found

Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis.

Shawn Ralston, Allan Lieberthal, H Meissner … (2014)

This guideline is a revision of the clinical practice guideline, "Diagnosis and Management of Bronchiolitis," published by the American Academy of Pediatrics in 2006. The guideline applies to children from 1 through 23 months of age. Other exclusions are noted. Each key action statement indicates level of evidence, benefit-harm relationship, and level of recommendation. Key action statements are as follows:

0 comments Cited 258 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Influence of nebulizer type, position, and bias flow on aerosol drug delivery in simulated pediatric and adult lung models during mechanical ventilation.

Essam A Aljamhan, James J Fink, Orçin Atalay … (2010)

The effectiveness of aerosol drug delivery during mechanical ventilation is influenced by the patient, ventilator, and nebulizer variables. The impact of nebulizer type, position on the ventilator circuit, and bias flow on aerosol drug delivery has not been established for different age populations. To determine the influence of nebulizer position and bias flow with a jet nebulizer and a vibrating-mesh nebulizer on aerosol drug delivery in simulated and mechanically ventilated pediatric and adult patients. Albuterol sulfate (2.5 mg) was nebulized with a jet nebulizer and a vibrating-mesh nebulizer, using simulated pediatric and adult lung models. The 2 nebulizer positions were: (1) jet nebulizer placed 15 cm from the Y-piece adapter, and vibrating-mesh nebulizer attached directly to the Y-piece; and (2) jet nebulizer placed prior to the heated humidifier with 15 cm of large-bore tubing, and vibrating-mesh nebulizer positioned at an inlet to the humidifier. A ventilator with a heated humidifier and ventilator circuit was utilized in both lung models. The adult ventilator settings were V(T) 500 mL, PEEP 5 cm H2O, respiratory rate 20 breaths/min, peak inspiratory flow 60 L/min, and descending ramp flow waveform. The pediatric ventilator settings were V(T) 100 mL, PEEP 5 cm H2O, respiratory rate 20 breaths/min, inspiratory time 1 s. We tested bias flows of 2 and 5 L/min. The adult and pediatric lung models used 8-mm and 5-mm inner-diameter endotracheal tubes, respectively. Each experiment was run 3 times (n = 3). The albuterol sulfate was eluted from the filter and analyzed via spectrophotometry (276 nm). Nebulizer placement prior to the humidifier increased drug delivery with both the jet nebulizer and the vibrating-mesh nebulizer, with a greater increase with the vibrating-mesh nebulizer. Higher bias flow reduced drug delivery. Drug delivery with the vibrating-mesh nebulizer was 2-4-fold greater than with the jet nebulizer at all positions (P < .05) in both lung models. During simulated mechanical ventilation in pediatric and adult models, bias flow and nebulizer type and position impact aerosol drug delivery.

0 comments Cited 63 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Reducing Aerosol-Related Risk of Transmission in the Era of COVID-19: An Interim Guidance Endorsed by the International Society of Aerosols in Medicine

James Fink, Stephan Ehrmann, Jie Li … (2020)

National and international guidelines recommend droplet/airborne transmission and contact precautions for those caring for coronavirus disease 2019 (COVID-19) patients in ambulatory and acute care settings. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, an acute respiratory infectious agent, is primarily transmitted between people through respiratory droplets and contact routes. A recognized key to transmission of COVID-19, and droplet infections generally, is the dispersion of bioaerosols from the patient. Increased risk of transmission has been associated with aerosol generating procedures that include endotracheal intubation, bronchoscopy, open suctioning, administration of nebulized treatment, manual ventilation before intubation, turning the patient to the prone position, disconnecting the patient from the ventilator, noninvasive positive-pressure ventilation, tracheostomy, and cardiopulmonary resuscitation. The knowledge that COVID-19 subjects can be asymptomatic and still shed virus, producing infectious droplets during breathing, suggests that health care workers (HCWs) should assume every patient is potentially infectious during this pandemic. Taking actions to reduce risk of transmission to HCWs is, therefore, a vital consideration for safe delivery of all medical aerosols. Guidelines for use of personal protective equipment (glove, gowns, masks, shield, and/or powered air purifying respiratory) during high-risk procedures are essential and should be considered for use with lower risk procedures such as administration of uncontaminated medical aerosols. Bioaerosols generated by infected patients are a major source of transmission for SARS CoV-2, and other infectious agents. In contrast, therapeutic aerosols do not add to the risk of disease transmission unless contaminated by patients or HCWs.