BACKGROUND Patients receiving mechanical ventilation often require airway clearance and inhaled therapies. Intrapulmonary percussive ventilation (IPV) combines a high-frequency percussive ventilator with a jet nebulizer. Data on aerosol delivery efficiency of the device are scarce. We evaluated albuterol delivery efficiency while using an IPV in-line adapter under different conditions. METHODS A pediatric lung model of invasive mechanical ventilation was used. The following independent variables were evaluated: lung condition (normal vs ARDS), ventilator mode (adaptive pressure ventilation vs pressure control), percent opening of adapter (0% vs 25% vs 50%), IPV driving pressure (25 psi vs 40 psi), IPV percussion setting (easy vs hard), and endotracheal tube (ETT) size (3.5 mm vs 5.5 mm). Albuterol delivery efficiency (mass captured in the filter expressed as percentage of loading dose) was selected as the dependent variable. Albuterol was captured on a filter at the tip of the ETT and quantified via spectrophotometry (276 nm). RESULTS Albuterol delivery efficiency ranged from 0-2.89%. Median (interquartile range) and 95% CI around the median were 0.54% (0.37-1.00) and 0.50-0.63%, respectively. The coefficient of determination (R2) for the model including all variables was 0.363. The 2 main contributors were percent of adapter opening (R2 0.30) and IPV setting (R2 0.039). CONCLUSIONS Albuterol delivery during invasive mechanical ventilation via in-line IPV in a pediatric lung model was inefficient. Alternative methods of delivering bronchodilators and other inhaled medications should be considered when IPV is used.

中文翻译：

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在儿科肺模型中通过在线肺内冲击通气进行有创机械通气期间的沙丁胺醇输送。

背景技术接受机械通气的患者通常需要气道清理和吸入治疗。肺内冲击通气 (IPV) 将高频冲击呼吸机与喷射雾化器相结合。有关该装置气雾剂输送效率的数据很少。我们评估了在不同条件下使用 IPV 串联适配器时沙丁胺醇的输送效率。方法 使用有创机械通气的儿科肺模型。评估了以下自变量：肺部状况（正常 vs ARDS）、呼吸机模式（自适应压力通气 vs 压力控制）、适配器打开百分比（0% vs 25% vs 50%）、IPV 驱动压力（25 psi vs 40 psi） ）、IPV 打击设置（简单与困难）以及气管插管 (ETT) 尺寸（3.5 毫米与 5.5 毫米）。选择沙丁胺醇输送效率（过滤器中捕获的质量，表示为负荷剂量的百分比）作为因变量。沙丁胺醇被 ETT 尖端的过滤器捕获，并通过分光光度法（276 nm）进行定量。结果 沙丁胺醇递送效率范围为 0-2.89%。中位数（四分位距）和中位数附近的 95% CI 分别为 0.54% (0.37-1.00) 和 0.50-0.63%。包含所有变量的模型的决定系数 (R2) 为 0.363。两个主要影响因素是适配器开口百分比 (R2 0.30) 和 IPV 设置 (R2 0.039)。结论 在儿科肺模型中有创机械通气期间通过串联 IPV 输送沙丁胺醇效率低下。使用 IPV 时，应考虑使用支气管扩张剂和其他吸入药物的替代方法。