Fang Tien-Pei, Lin Hui-Ling, Chiu Shu-Hua, Wang Szu-Hui, DiBlasi Robert M, Tsai Ying-Huang, Fink James B
1 Department of Respiratory Therapy, Chang Gung Memorial Hospital , Chiayi, Taiwan .
6 Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus, Taiwan .
J Aerosol Med Pulm Drug Deliv. 2016 Oct;29(5):447-453. doi: 10.1089/jamp.2015.1265. Epub 2016 Mar 14.
High frequency oscillatory ventilation (HFOV) is used in critically ill patients with severe hypoxemic respiratory failure. The purpose of this in vitro study was to determine the efficiency of aerosol delivery with different lung parameters during simulated neonatal, pediatric, and adult HFOV.
Sensormedics 3100A/B ventilators were used to deliver infant, pediatric, and adult HFOV. Two types of aerosol generators were chosen for testing: 1) a continuous jet nebulizer (JN) with a unit-dose of 5.0 mg/2.5 mL salbutamol sulfate diluted into 4 mL, and 2) a vibrating mesh nebulizer (VMN) with salbutamol sulfate were run to completion of aerosol generation. Both aerosol devices were placed 1) between the ventilator circuit and the endotracheal tube (ETT) (proximal position); and 2) at the inlet of the heated humidifier (distal position) (n = 5). Drug was collected on a bacterial filter placed distal to the ETT, and the drug eluted and analyzed with a UV Spectrophotometer at 276 nm. T- test and ANOVA tests were used for comparison (p < 0.05).
The inhaled drug delivered by JN was 0%-0.6% of the nominal dose when placed at distal position, and 0%-3% at proximal position (p < 0.01), while the VMN was 0%-0.5% at distal and 8.6%-22.7% at proximal position (p < 0.01). Aerosol delivery during HFOV was greater with adult settings than pediatric and infant settings with VMN and JN (22.7%, 8.6%, and 17.4% respectively, p < 0.01). When the aerosol delivery device was placed at the distal position, negligible drug mass was observed (<0.5%), regardless of the nebulizer device used.
During HFOV, aerosol delivery with the nebulizer placed at proximal was greater than placement distal from the ETT, with VMN delivering more drug than JN. The inhaled drug was delivery correlated positively with ETT size, MAP, and bias flow, and inversely proportional to power settings.
高频振荡通气（HFOV）用于患有严重低氧血症呼吸衰竭的危重症患者。这项体外研究的目的是确定在模拟新生儿、儿科和成人HFOV期间，不同肺部参数下气溶胶给药的效率。
使用Sensormedics 3100A/B呼吸机进行婴儿、儿科和成人HFOV通气。选择两种类型的气溶胶发生器进行测试：1）一种连续喷射雾化器（JN），将5.0mg/2.5mL硫酸沙丁胺醇单剂量稀释至4mL；2）一种使用硫酸沙丁胺醇的振动网式雾化器（VMN），运行至气溶胶生成完成。两种气溶胶装置分别放置在：1）呼吸机回路与气管内导管（ETT）之间（近端位置）；2）加热湿化器入口处（远端位置）（n = 5）。药物收集在放置于ETT远端的细菌滤器上，洗脱后用紫外分光光度计在276nm处进行分析。采用t检验和方差分析进行比较（p < 0.05）。
当JN放置在远端位置时，吸入药物占标称剂量的0%-0.6%，放置在近端位置时为0%-3%（p < 0.01），而VMN在远端为0%-0.5%，在近端为8.6%-22.7%（p < 0.01）。使用VMN和JN时，成人设置下HFOV期间的气溶胶给药量大于儿科和婴儿设置（分别为22.7%、8.6%和17.4%，p < 0.01）。当气溶胶给药装置放置在远端位置时，无论使用何种雾化器装置，观察到的药物量都可以忽略不计（<0.5%）。
在HFOV期间，将雾化器放置在近端时的气溶胶给药量大于放置在ETT远端时，VMN的给药量比JN更多。吸入药物的给药量与ETT尺寸、平均气道压（MAP）和偏流呈正相关，与功率设置呈负相关。
