Ari Arzu, Harwood Robert, Sheard Meryl, Alquaimi Maher Mubarak, Alhamad Bshayer, Fink James B
Department of Respiratory Therapy, Georgia State University, Atlanta, Georgia.
University of Dammam, Dammam, Saudi Arabia.
Respir Care. 2016 May;61(5):600-6. doi: 10.4187/respcare.04127. Epub 2016 Feb 23.
Aerosol and humidification therapy are used in long-term airway management of critically ill patients with a tracheostomy. The purpose of this study was to determine delivery efficiency of jet and mesh nebulizers combined with different humidification systems in a model of a spontaneously breathing tracheotomized adult with or without exhaled heated humidity.
An in vitro model was constructed to simulate a spontaneously breathing adult (tidal volume, 400 mL; breathing frequency, 20 breaths/min; inspiratory-expiratory ratio, 1:2) with a tracheostomy using a teaching manikin attached to a test lung through a collecting filter (Vital Signs Respirgard II). Exhaled heat and humidity were simulated using a cascade humidifier set to deliver 37°C and >95% relative humidity. Albuterol sulfate (2.5 mg/3 mL) was administered with a jet nebulizer (AirLife Misty Max) operated at 10 L/min and a mesh nebulizer (Aeroneb Solo) using a heated pass-over humidifier, unheated large volume humidifier both at 40 L/min output and heat-and-moisture exchanger. Inhaled drug eluted from the filter was analyzed via spectrophotometry (276 nm).
Delivery efficiency of the jet nebulizer was less than that of the mesh nebulizer under all conditions (P < .05). Aerosol delivery with each nebulizer was greatest on room air and lowest when heated humidifiers with higher flows were used. Exhaled humidity decreased drug delivery up to 44%.
The jet nebulizer was less efficient than the mesh nebulizer in all conditions tested in this study. Aerosol deposition with each nebulizer was lowest with the heated humidifier with high flow. Exhaled humidity reduced inhaled dose of drug compared with a standard model with nonheated/nonhumidified exhalation. Further clinical research is warranted to understand the impact of exhaled humidity on aerosol drug delivery in spontaneously breathing patients with tracheostomy using different types of humidifiers.
雾化和气湿化治疗用于气管切开的重症患者的长期气道管理。本研究的目的是在有或没有呼出热湿化的自主呼吸气管切开成年模型中，确定喷射雾化器和网式雾化器与不同湿化系统联合使用时的输送效率。
构建体外模型，使用通过收集过滤器（生命体征Respirgard II）连接到测试肺的教学人体模型，模拟自主呼吸的成年气管切开患者（潮气量400 mL；呼吸频率20次/分钟；吸呼比1:2）。使用设置为输送37°C和>95%相对湿度的级联加湿器模拟呼出的热量和湿度。硫酸沙丁胺醇（2.5 mg/3 mL）通过以10 L/分钟运行的喷射雾化器（AirLife Misty Max）和使用加热型旁通加湿器、输出量均为40 L/分钟的非加热大容量加湿器以及热湿交换器的网式雾化器（Aeroneb Solo）给药。通过分光光度法（276 nm）分析从过滤器洗脱的吸入药物。
在所有条件下，喷射雾化器的输送效率均低于网式雾化器（P < .05）。每种雾化器的气溶胶输送在室内空气中最大，在使用较高流量的加热加湿器时最低。呼出湿度使药物输送降低高达44%。
在本研究测试的所有条件下，喷射雾化器的效率均低于网式雾化器。每种雾化器的气溶胶沉积在高流量加热加湿器时最低。与非加热/非湿化呼出的标准模型相比，呼出湿度降低了吸入药物剂量。有必要进行进一步的临床研究，以了解呼出湿度对使用不同类型加湿器的自主呼吸气管切开患者气溶胶药物输送的影响。
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