Sutherasan Yuda, Ball Lorenzo, Raimondo Pasquale, Caratto Valentina, Sanguineti Elisa, Costantino Federico, Ferretti Maurizio, Kacmarek Robert M, Pelosi Paolo
IRCCS AOU San Martino-IST, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
Division of pulmonary and critical care medicine, Faculty of medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
BMC Pulm Med. 2017 Jan 10;17(1):9. doi: 10.1186/s12890-016-0347-5.
Few studies have investigated the factors affecting aerosol delivery during non-invasive ventilation (NIV). Our aim was to investigate, using a bench-top model, the effect of different ventilator settings and positions of the exhalation port and nebulizer on the amount of albuterol delivered to a lung simulator.
A lung model simulating spontaneous breathing was connected to a single-limb NIV ventilator, set in bi-level positive airway pressure (BIPAP) with inspiratory/expiratory pressures of 10/5, 15/10, 15/5, and 20/10 cmHO, or continuous positive airway pressure (CPAP) of 5 and 10 cmHO. Three delivery circuits were tested: a vented mask with the nebulizer directly connected to the mask, and an unvented mask with a leak port placed before and after the nebulizer. Albuterol was collected on a filter placed after the mask and then the delivered amount was measured with infrared spectrophotometry.
Albuterol delivery during NIV varied between 6.7 ± 0.4% to 37.0 ± 4.3% of the nominal dose. The amount delivered in CPAP and BIPAP modes was similar (22.1 ± 10.1 vs. 24.0 ± 10.0%, p = 0.070). CPAP level did not affect delivery (p = 0.056); in BIPAP with 15/5 cmHO pressure the delivery was higher compared to 10/5 cmHO (p = 0.033) and 20/10 cmHO (p = 0.014). Leak port position had a major effect on delivery in both CPAP and BIPAP, the best performances were obtained with the unvented mask, and the nebulizer placed between the leak port and the mask (p < 0.001).
In this model, albuterol delivery was marginally affected by ventilatory settings in NIV, while position of the leak port had a major effect. Nebulizers should be placed between an unvented mask and the leak port in order to maximize aerosol delivery.
很少有研究调查无创通气（NIV）期间影响气雾剂输送的因素。我们的目的是使用台式模型研究不同的呼吸机设置、呼气端口和雾化器的位置对输送到肺模拟器中的沙丁胺醇量的影响。
将模拟自主呼吸的肺模型连接到单回路NIV呼吸机，设置为双水平气道正压（BIPAP），吸气/呼气压力分别为10/5、15/10、15/5和20/10 cmH₂O，或持续气道正压（CPAP）为5和10 cmH₂O。测试了三种输送回路：雾化器直接连接到面罩的通气面罩，以及在雾化器前后设有泄漏口的无通气面罩。沙丁胺醇收集在面罩后的过滤器上，然后用红外分光光度法测量输送量。
NIV期间沙丁胺醇的输送量在标称剂量的6.7±0.4%至37.0±4.3%之间变化。CPAP和BIPAP模式下的输送量相似（22.1±10.1%对24.0±10.0%，p = 0.070）。CPAP水平不影响输送量（p = 0.056）；在压力为15/5 cmH₂O的BIPAP中，输送量高于10/5 cmH₂O（p = 0.033）和20/10 cmH₂O（p = 0.014）。泄漏口位置对CPAP和BIPAP中的输送量有重大影响，无通气面罩且雾化器置于泄漏口和面罩之间时性能最佳（p < 0.001）。
在该模型中，NIV中的通气设置对沙丁胺醇输送量的影响较小，而泄漏口位置有重大影响。雾化器应置于无通气面罩和泄漏口之间，以实现气雾剂输送量最大化。
