El Taoum Katia K, Xi Jinxiang, Kim JongWong, Berlinski Ariel
Department of Pediatrics, Pulmonology Section, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Department of Mechanical and Biomedical Engineering, Central Michigan University, Mount Pleasant, Michigan.
Respir Care. 2015 Jul;60(7):1015-25. doi: 10.4187/respcare.03606. Epub 2015 Jan 13.
Infants and young children are obligate nose breathers; therefore, a transnasal route seems the logical delivery method of inhaled aerosols. The efficiency of aerosol delivery depends on several factors, such as interface, type of nebulizer, and patient age and breathing pattern. We hypothesized that the use of a vibrating mesh nebulizer, a tight-fitting face mask, and a head model and breathing pattern of an older child would result in a higher lung dose. We also hypothesized that the use of an anatomically correct model would more accurately reflect lung dose than models that do not include airways.
A model comprising a breathing simulator and an anatomically correct model of a 7-month-old infant and a 5-y-old child with an interposed collection filter (lung dose) were used. Breathing patterns of a newborn, infant, and child were used with 7 interfaces. A continuous output and a vibrating mesh nebulizer were loaded with albuterol sulfate solution (5 mg/3.5 mL) and operated for 5 min. Albuterol mass was determined via spectrophotometer (276 nm).
Lung dose varied between 0 and 3%. The jet nebulizer was more efficient than the vibrating mesh nebulizer. The front-loaded mask was the most efficient interface. We also found that higher tidal volumes were associated with higher lung doses and that the use of a larger airway model resulted in a lower lung dose. Finally, the model showed a good correlation with in vivo data and rendered lung doses severalfold lower than previous data obtained with oral models.
Careful pairing of the aerosol generator and interface is very important during transnasal aerosol delivery.
婴幼儿是必须经鼻呼吸的；因此，经鼻途径似乎是吸入气雾剂的合理给药方式。气雾剂给药的效率取决于几个因素，如接口、雾化器类型以及患者年龄和呼吸模式。我们假设，使用振动网式雾化器、贴合紧密的面罩以及较大儿童的头部模型和呼吸模式会导致更高的肺部剂量。我们还假设，与不包括气道的模型相比，使用解剖结构正确的模型能更准确地反映肺部剂量。
使用一个由呼吸模拟器以及一个7个月大婴儿和一个5岁儿童的解剖结构正确的模型组成的模型，中间插入收集过滤器（肺部剂量）。将新生儿、婴儿和儿童的呼吸模式与7种接口配合使用。向连续输出型雾化器和振动网式雾化器中装入硫酸沙丁胺醇溶液（5毫克/3.5毫升），并运行5分钟。通过分光光度计（276纳米）测定沙丁胺醇的质量。
肺部剂量在0%至3%之间变化。喷射式雾化器比振动网式雾化器更有效。前置式面罩是最有效的接口。我们还发现，潮气量越大，肺部剂量越高，并且使用较大气道模型会导致较低的肺部剂量。最后，该模型与体内数据显示出良好的相关性，并且得出的肺部剂量比之前使用口腔模型获得的数据低几倍。
在经鼻气雾剂给药过程中，仔细匹配气雾剂发生器和接口非常重要。
