Ari Arzu, de Andrade Armele Dornelas, Sheard Meryl, AlHamad Bshayer, Fink James B
1 Department of Respiratory Therapy, Georgia State University , Atlanta, Georgia .
2 Department of Physical Therapy, University Federal of Pernambuco , Recife, Brazil .
J Aerosol Med Pulm Drug Deliv. 2015 Aug;28(4):281-9. doi: 10.1089/jamp.2014.1149. Epub 2014 Dec 10.
Different types of nebulizers and interfaces are used for the treatment of adults and children with pulmonary diseases. The purpose of this study was to determine the efficiency of a mesh nebulizer (MN) with a proprietary adapter and a jet nebulizer (JN) under different configurations in adult and pediatric models of spontaneous breathing. We hypothesize that delivery efficiency of JN and MN will differ depending on the interface used during aerosol therapy in simulated spontaneously breathing adult and pediatric models. While we expect that aerosol delivery with JN will be less efficient than MN, we also hypothesize that lung deposition obtained with the adult lung model will be more than that with the pediatric lung model in all conditions tested in this study.
A lung model using a teaching manikin connected to a sinusoidal pump via a collecting filter at the level of the bronchi simulating a spontaneously breathing adult (Vt 500 mL, RR 15 bpm, I:E ratio 1:2) or pediatric patient (Vt 150 mL, RR 25 bpm, I:E ratio 1:2). Albuterol sulfate (2.5 mg/3 mL) was aerosolized with JN (Mistymax 10, Airlife) or MN (Aerogen Solo(®), Aerogen) with the Adapter (Aerogen Solo(®) Adapter, Aerogen Ltd, Galway, Ireland) using mouthpiece, aerosol mask, and valved-mask in adults and the dragon mask, aerosol mask, and valved-mask in pediatrics (n=3). The Adapter, specifically designed for MN, was attached to all the interfaces used in this study with supplemental oxygen of 2 lpm, and in addition, the MP was tested with no additional flow in the adult model. The JN was driven with 10 lpm based on the manufacturer's label. Drug was eluted from the filter and analyzed via spectrophotometry. Descriptive statistics, dependent t-test and one-way analysis of variance were used for data analysis. Significant level was set at 0.05.
In adults, delivery efficiency of JN with the valved mask was significantly greater than that with the aerosol mask (p=0.01). Aerosol delivery of JN with the mouthpiece was not statistically significant from the valved mask (p=0.123) and the aerosol mask (p=0.193). Drug delivery with MN with mouthpiece (15.42±1.4%) and valved-mask (15.15±1.1%) was greater than the open aerosol mask (7.54±0.39%; p=0.0001) in the adult lung model. With no flow mouthpiece delivery increased>2 fold (34.9±3.1%; p=.0001) compared to use of 2 lpm of flow. Using the JN with the pediatric model deposition with valved-mask (5.3±0.8%), dragon mask (4.7±0.9%), and aerosol mask (4.1±0.3%) were similar (p>0.05); while drug delivery with MN via valved-mask (11.1±0.7%) was greater than the dragon mask (6.44±0.3%; p=0.002) and aerosol mask (4.6±0.4%; p=0.002), and the dragon mask was more efficient than the open aerosol mask (p=0.009) CONCLUSION: The type of nebulizer and interface used for aerosol therapy affects delivery efficiency in these simulated spontaneously breathing adult and pediatric models. Drug delivery was greatest with the valved-mouthpiece and mask with JN and MN, while the standard aerosol mask was least efficient in these simulated spontaneously breathing adult and pediatric lung models. Delivery efficiency of JN was less than MN in all conditions tested in this study except in the aerosol mask. Lung deposition obtained with the adult lung model was more than that with the pediatric lung model.
不同类型的雾化器和接口用于治疗患有肺部疾病的成人和儿童。本研究的目的是确定在成人和儿童自主呼吸模型中，使用专利适配器的网状雾化器（MN）和喷射雾化器（JN）在不同配置下的效率。我们假设，在模拟的成人和儿童自主呼吸模型中进行气溶胶治疗时，JN和MN的输送效率会因所使用的接口而异。虽然我们预计JN的气溶胶输送效率低于MN，但我们还假设，在本研究测试的所有条件下，成人肺模型获得的肺部沉积将多于儿童肺模型。
使用一个教学人体模型连接到一个正弦泵，通过支气管水平的收集过滤器模拟自主呼吸的成人（潮气量500 mL，呼吸频率15次/分钟，吸呼比1:2）或儿童患者（潮气量150 mL，呼吸频率25次/分钟，吸呼比1:2）的肺模型。使用JN（Mistymax 10，Airlife）或MN（Aerogen Solo(®)，Aerogen），搭配适配器（Aerogen Solo(®) Adapter，Aerogen Ltd，戈尔韦，爱尔兰），在成人中使用口含器、气溶胶面罩和带阀面罩，在儿童中使用龙形面罩、气溶胶面罩和带阀面罩（n = 3）雾化硫酸沙丁胺醇（2.5 mg/3 mL）。专为MN设计的适配器连接到本研究中使用的所有接口，并补充2升/分钟的氧气，此外，在成人模型中对口含器在无额外气流的情况下进行了测试。根据制造商的标签，JN以10升/分钟的流量驱动。药物从过滤器中洗脱并通过分光光度法进行分析。使用描述性统计、相关样本t检验和单因素方差分析进行数据分析。显著性水平设定为0.05。
在成人中，JN使用带阀面罩时的输送效率显著高于使用气溶胶面罩时（p = 0.01）。JN使用口含器时的气溶胶输送与带阀面罩（p = 0.123）和气溶胶面罩（p = 0.193）相比无统计学差异。在成人肺模型中，MN使用口含器（15.42±1.4%）和带阀面罩（15.15±1.1%）时的药物输送量大于开放式气溶胶面罩（7.54±0.39%；p = 0.0001）。与使用2升/分钟气流相比，无气流时口含器的输送量增加了2倍以上（34.9±3.1%；p = 0.0001）。在儿童模型中，使用JN时，带阀面罩（5.3±0.8%）、龙形面罩（4.7±0.9%）和气溶胶面罩（4.1±0.3%）的沉积量相似（p>0.05）；而MN通过带阀面罩（11.1±0.7%）的药物输送量大于龙形面罩（6.44±0.3%；p = 0.002）和气溶胶面罩（4.6±0.4%；p = 0.002），且龙形面罩比开放式气溶胶面罩更有效（p = 0.009）。结论：用于气溶胶治疗的雾化器类型和接口会影响这些模拟的成人和儿童自主呼吸模型中的输送效率。使用JN和MN时，带阀口含器和面罩的药物输送量最大，而在这些模拟的成人和儿童自主呼吸肺模型中，标准气溶胶面罩的效率最低。在本研究测试的所有条件下，除了气溶胶面罩外，JN的输送效率低于MN。成人肺模型获得的肺部沉积多于儿童肺模型。
