Alhamad Bshayer R, Fink James B, Harwood Robert J, Sheard Meryl M, Ari Arzu
Division of Respiratory Therapy, Georgia State University, Atlanta, Georgia.
Respir Care. 2015 Jul;60(7):1026-32. doi: 10.4187/respcare.03592. Epub 2015 Mar 3.
This study was conducted to compare the efficiency of jet nebulizers, vibrating mesh nebulizers, and pressurized metered-dose inhalers (pMDI) during assisted and unassisted administration techniques using a simulated spontaneously breathing pediatric model with a tracheostomy tube (TT).
An in vitro breathing model consisting of an uncuffed TT (4.5-mm inner diameter) was attached to a collecting filter (Respirgard) connected to a dual-chamber test lung and a ventilator (Hamilton Medical) to simulate breathing parameters of a 2-y-old child (breathing frequency, 25 breaths/min; tidal volume, 150 mL; inspiratory time, 0.8 s; peak inspiratory flow, 20 L/min). Albuterol sulfate was administered using a jet nebulizer (MicroMist, 2.5 mg/3 mL), vibrating mesh nebulizer (Aeroneb Solo, 2.5 mg/3 mL), and pMDI (ProAir HFA, 432 μg). Each device was tested 5 times with an unassisted technique (direct administration of aerosols with simulated spontaneous breathing) and with an assisted technique (using a manual resuscitation bag in conjunction with an aerosol device and synchronized with inspiration). Drug collected on the filter was analyzed by spectrophotometry.
With the unassisted technique, the pMDI had the highest inhaled mass percent (IM%, 47.15 ± 7.82%), followed by the vibrating mesh nebulizer (19.77 ± 2.99%) and the jet nebulizer (5.88 ± 0.77%, P = .002). IM was greater with the vibrating mesh nebulizer (0.49 ± .07 mg) than with the pMDI (0.20 ± 0.03 mg) and the jet nebulizer (0.15 ± 0.01 mg, P = .007). The trend of lower deposition with the assisted versus unassisted technique was not significant for the jet nebulizer (P = .46), vibrating mesh nebulizer (P = .19), and pMDI (P = .64).
In this in vitro pediatric breathing model with a TT, the pMDI delivered the highest IM%, whereas the vibrating mesh nebulizer delivered the highest IM. The jet nebulizer was the least efficient device. Delivery efficiency was similar with unassisted and assisted administration techniques.
本研究旨在使用带有气管造口管（TT）的模拟自主呼吸儿科模型，比较喷射雾化器、振动网孔雾化器和压力定量吸入器（pMDI）在辅助和非辅助给药技术下的效率。
一个由无套囊TT（内径4.5毫米）组成的体外呼吸模型连接到一个收集过滤器（Respirgard），该过滤器连接到一个双腔测试肺和一台呼吸机（Hamilton Medical），以模拟2岁儿童的呼吸参数（呼吸频率，25次/分钟；潮气量，150毫升；吸气时间，0.8秒；吸气峰值流速，20升/分钟）。使用喷射雾化器（MicroMist，2.5毫克/3毫升）、振动网孔雾化器（Aeroneb Solo，2.5毫克/3毫升）和pMDI（ProAir HFA，432微克）给予硫酸沙丁胺醇。每个装置分别采用非辅助技术（模拟自主呼吸直接给予气雾剂）和辅助技术（使用手动复苏袋与气雾剂装置配合并与吸气同步）进行5次测试。收集在过滤器上的药物通过分光光度法进行分析。
在非辅助技术下，pMDI的吸入质量百分比（IM%）最高（47.15±7.82%），其次是振动网孔雾化器（19.77±2.99%）和喷射雾化器（5.88±0.77%，P = 0.002）。振动网孔雾化器的IM（0.49±0.07毫克）大于pMDI（0.20±0.03毫克）和喷射雾化器（0.15±0.01毫克，P = 0.007）。对于喷射雾化器（P = 0.46）、振动网孔雾化器（P = 0.19）和pMDI（P = 0.64），辅助技术与非辅助技术相比沉积较低的趋势不显著。
在这个带有TT的体外儿科呼吸模型中，pMDI的IM%最高，而振动网孔雾化器的IM最高。喷射雾化器是效率最低的装置。非辅助和辅助给药技术的给药效率相似。
