Department of Physical Therapy.
Respir Care. 2014 Mar;59(3):328-33. doi: 10.4187/respcare.02291. Epub 2013 Aug 6.
The Acapella device produces high-frequency oscillations and positive expiratory pressure to promote bronchial secretion clearance. Its performance during aerosol delivery has not been described. We evaluated the effect of nebulizer and Acapella configuration on pulmonary deposition of radio-tagged aerosol in healthy subjects.
Ten healthy male subjects (mean age 24.4 ± 2.2 y) participated in a crossover study that compared pulmonary delivery of 4 mL of technetium-99m-labeled diethylene triamine penta-acetic acid (25 mCi) and 0.9% saline solution via jet nebulizer. We tested 3 configurations: nebulizer attached to the distal end of the Acapella; nebulizer placed between the mouthpiece and the Acapella; and nebulizer alone (control). With scintigraphy we measured radio-aerosol deposition in 6 lung regions: upper, middle, lower, central, intermediate, and peripheral.
Deposition was similar between the right and left lungs, with no significant differences between device configurations. Lung deposition was less with the nebulizer attached to the Acapella than with nebulizer between the mouthpiece and the Acapella (P = .001, for both lungs) or without the Acapella (P = .003 and P = .001 for the right and left lungs, respectively). There was no significant difference between the setup without Acapella and the setup with the nebulizer between the mouthpiece and the Acapella (P = .001, for both lungs). On the vertical axis, deposition was lower with the nebulizer attached to the distal end of the Acapella than with the nebulizer between the mouthpiece and the Acapella (upper region P < .001, middle region P = .001, lower region P = .003), and lower with the nebulizer attached to the distal end of the Acapella than with the setup without Acapella (upper and middle region both P = .001, lower region P = .002), with up to a 3-fold difference in the middle and lower regions. On the central-peripheral axis, deposition was lower with the nebulizer attached to the distal end of the Acapella than with the nebulizer between the mouthpiece and the Acapella (central region P < .001, peripheral region P < .001), and lower with the nebulizer attached to the distal end of the Acapella than with the setup without Acapella (central and peripheral regions both P = .002), with differences of 3-4-fold between the central and peripheral regions.
Placing the nebulizer distal to the Acapella, as recommended by the manufacturer, decreased intrapulmonary deposition, compared to placing the nebulizer between the Acapella and the patient airway, or delivering aerosol without the Acapella in the circuit. (ClinicalTrials.gov NCT01102166).
Acapella 装置产生高频振荡和正呼气压力，以促进支气管分泌物清除。其在气溶胶输送过程中的性能尚未描述。我们评估了雾化器和 Acapella 配置对健康受试者放射性标记气溶胶肺沉积的影响。
10 名健康男性受试者（平均年龄 24.4 ± 2.2 岁）参与了一项交叉研究，比较了通过射流雾化器输送 4 毫升放射性标记的二亚乙基三胺五乙酸（25mCi）和 0.9%生理盐水溶液的肺输送。我们测试了 3 种配置：雾化器连接到 Acapella 的远端；雾化器放置在吸嘴和 Acapella 之间；和单独的雾化器（对照）。通过闪烁照相术，我们测量了 6 个肺区的放射性气溶胶沉积：上、中、下、中、中、外周。
右肺和左肺之间的沉积相似，装置配置之间无显著差异。与雾化器置于 Acapella 和吸嘴之间（均 P =.001）或不使用 Acapella（右肺 P =.003，左肺 P =.001）相比，雾化器与 Acapella 相连时的肺沉积减少。（P =.001）。无 Acapella 装置与雾化器置于吸嘴和 Acapella 之间的装置之间无显著差异（均 P =.001）。在垂直轴上，与雾化器置于吸嘴和 Acapella 之间相比，雾化器连接到 Acapella 的远端时沉积较低（上区 P <.001，中区 P =.001，下区 P =.003），与无 Acapella 装置相比沉积较低（上区和中区均 P =.001，下区 P =.002），中区和下区差异达 3 倍。在中央-外周轴上，与雾化器置于吸嘴和 Acapella 之间相比，雾化器连接到 Acapella 的远端时沉积较低（中央区 P <.001，外周区 P <.001），与无 Acapella 装置相比，雾化器连接到 Acapella 的远端时沉积较低（中央和外周区均 P =.002），中央和外周区之间的差异为 3-4 倍。
与将雾化器放置在 Acapella 和患者气道之间或在没有 Acapella 的情况下输送气溶胶相比，按照制造商的建议将雾化器放置在 Acapella 远端可减少肺内沉积。（ClinicalTrials.gov NCT01102166）。
