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In vitro comparison between inspiration synchronized and continuous vibrating mesh nebulizer during trans-nasal aerosol delivery
Intensive Care Medicine Experimental Pub Date : 2020-01-31 , DOI: 10.1186/s40635-020-0293-7
Jie Li 1 , Wei Wu 2 , James B Fink 1, 3
Affiliation  

Background Compared to continuous vibrating mesh nebulizer (VMN), inspiration synchronized VMN has shown increased inhaled dose during noninvasive ventilation; however, its use during aerosol delivery via high-flow nasal cannula (HFNC) is still unknown. Methods An adult manikin was connected to a dual-chamber model lung, which was driven by a critical care ventilator to simulate spontaneous breathing. A HFNC system was utilized with temperature at 37 ° C while gas flow at 5, 10, 20, 40, and 60 L/min. Inspiration synchronized and continuous aerosol generation were compared at different positions (at the inlet of humidifier vs close to patient). One milliliter of albuterol (2.5 mg/mL) was used in each run ( n = 3). Collection filter was placed at the trachea and was removed after each run. Drug was eluted from the filter and assayed with UV spectrophotometry (276 nm). Results When nebulizer was placed close to patient, inhaled dose was higher with inspiration synchronized than continuous aerosol generation at all gas flows ( p = 0.05) except at 5 L/min. When placed at the inlet of humidifier, compared to continuous, inspiration synchronized aerosol generated higher inhaled dose with gas flow set below 50% of patient inspiratory flow [23.9 (20.6, 28.3)% vs 18.1 (16.7, 19.6)%, p < 0.001], but lower inhaled dose with gas flow set above 50% of patient inspiratory flow [3.5 (2.2, 9.3)% vs 9.9 (8.2, 16.4)%, p = 0.001]. Regardless of breathing pattern, continuous aerosol delivered greater inhaled dose with nebulizer placed at humidifier than close to patient at all gas flows except at 5 L/min. Conclusion When the HFNC gas flow was set higher than 50% of patient inspiratory flow, no significant advantage was found in inspiration synchronized over continuous aerosol. However, inspiration synchronized aerosol generated 30% more inhaled dose than continuous with gas flow set below 50% of patient inspiratory flow, regardless of nebulizer placement. Continuous nebulizer needs to be placed at the inlet of humidifier.

中文翻译:

经鼻气雾剂给药过程中吸气同步和连续振动网状雾化器的体外比较

背景 与连续振动网状雾化器 (VMN) 相比,吸气同步 VMN 在无创通气期间显示出吸入剂量增加;然而,它在通过高流量鼻插管 (HFNC) 进行气雾剂输送期间的使用仍然未知。方法 将成人人体模型连接到双腔模型肺,由重症监护呼吸机驱动模拟自主呼吸。使用 HFNC 系统,温度为 37°C,气体流速为 5、10、20、40 和 60 L/min。在不同位置(在加湿器入口处与靠近患者处)比较了吸气同步和连续气溶胶生成。每次运行使用 1 毫升沙丁胺醇 (2.5 mg/mL) (n = 3)。收集过滤器放置在气管处,并在每次运行后取出。从过滤器上洗脱药物并用紫外分光光度法 (276 nm) 进行分析。结果 当雾化器靠近患者放置时,除以 5 L/min 外,在所有气流条件下(p = 0.05),与吸气同步的吸入剂量均高于连续气溶胶生成。当放置在加湿器的入口处时,与连续吸气同步气雾剂相比,当气流设置在患者吸气流量的 50% 以下时,产生更高的吸入剂量 [23.9 (20.6, 28.3)% vs 18.1 (16.7, 19.6)%, p < 0.001 ],但气体流量设置在患者吸气流量的 50% 以上时吸入剂量较低 [3.5 (2.2, 9.3)% vs 9.9 (8.2, 16.4)%, p = 0.001]。无论呼吸模式如何,在除 5 L/min 以外的所有气体流量下,与靠近患者的雾化器放置在加湿器处相比,连续气雾剂输送的吸入剂量更大。结论 当 HFNC 气体流量设置为高于患者吸气流量的 50% 时,与连续气雾剂相比,同步吸气没有发现显着优势。然而,无论雾化器的位置如何,吸气同步气雾剂产生的吸入剂量比连续气雾剂产生的吸入剂量多 30%,气体流量设置为低于患者吸气流量的 50%。连续雾化器需要放置在加湿器的入口处。
更新日期:2020-01-31
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