Evaluation of Aerosol Delivery by MicroBase Mechanical Ventilation Nebulizer and Jet Nebulizer atTwo Locations in Adult Mechanical Ventilator

評估微邦呼吸器霧化器和噴射霧化器在成人呼吸器上兩種擺放位置的藥物傳遞量

Yu-Yao Kao ； Chi-Shan Hung ； Yu-Chung Hsu ； Chia-Chen Huang ； Eric Y.T. Chen ； Hui-Ling Lin

《呼吸治療》 16卷2期 (2017/07) Pp. 29-30

https://doi.org/10.6269/JRT.2017.16.2.04

摘要

Introduction: Aerosol drug delivery through mechanical ventilation is pervasivelyapplied to hospitalized patients in intensive care unit, respiratory care center and ward. Current delivery method heavily relies on small volume jet nebulizers (SVN). Despite its low cost, it severely suffers from general inefficiency due to high residual volume, troublesome operation instigated by drug dilution, requirement of additional gas supply, and significantly reduced drug deliveryefficacy. In order to resolve existing dilemma, anew vibrating-mesh nebulizer, the MicroBase mechanical ventilation nebulizer (μMVN),was developed specifically for mechanical ventilation system. The purpose of this study was to compare the efficacy of μMVN and SVNon delivering to drugs by placed at two locations in adult mechanical ventilation. Methods: The particle size ofμMVNwas 4.91 μm and 2.05 μm for SVN. A ventilator (SERVO-i; Maquet Inc) setting withadult parameters (tidal volume 600 mL, reparatory rate 16 breaths/min, inspiratory time 0.9 second, and PEEP 5 cmH_2O) was connected via an endotracheal tube and the hydrophobic bacterial filter (VADI Medical Technology CO, Ltd) to a single test lung (TTL, Michigan Instrument Inc). A unit dose of Combivent (Boehringer Ingelheim Co)or Pulmicort (AstraZeneca Co) was first added toμMVN (MicroBase Technology Co, Taiwan) andSVN (GaleMed Corp). While μMVNwas directly connected to a controller in the ventilator system, the SVNwas powered by oxygen flow at 6 L/min (n = 5). Both types of nebulizers werethen placed between the inspiratory limb of the ventilator circuit and the Y-piece or before the heated humidifier chamber (HH; MR370, Fisher & Paykel Healthcare). Drug collected in filter (inhaled and exhaled)was eluted and analyzed with a spectrophotometer (BioMate 3S UV-visible, Thermo Fisher Scientific) at wavelength 276 nm for Combivent and 254nm for Pulmicort. Statistical analyses were performed using SPSS 23.0 (SPSS, Chicago, Illinois).The independent samples t-test was used for statistical analysis, and p＜ 0.05 was used for statistical significance. Results and Conclusions: Figure 1compared both inhaled and exhaled mass % of total dose for both Combivent and Pulmicort at Y-piece and HH locations. The inhaled mass % ofboth drugs using μMVN was ～1. and ～2.0 fold higher than SVN at Y-piece and HH, respectively (p＜0.001). Furthermore, μMVN had generated higher inhaled mass % data for both Y-piece and HH using water soluble Combivent than Pulmicort (suspension drug). Exhaled mass of each nebulizer at HH was significantly lower than at Y-piece (p＜0.001). Hence, our data revealed that the aerosol drug delivery efficacy ofthe μMVNat Y-piece and before HH was higher than that of jet nebulizer on mechanical ventilator. Therefore, our data indicated that μMVN was more efficient and effective in delivering aerosol medicine at both locations on the ventilator which may serve as an optimized mechanical ventilator-based drug delivery during mechanical ventilation.

關鍵字

aerosol drug delivery ； vibrating-mesh nebulizer ； small volume jet nebulizer ； bronchodilator ； mechanical ventilation ； nebulizer location