Hassan Ahmed, Salah Eldin Randa, Abdelrahman Maha M, Abdelrahim Mohamed E
a Hospital Pharmacy Department , Beba General Hospital , Beni-suef , Egypt.
b Respiratory Department , Faculty of Medicine, Beni-suef University , Beni-suef , Egypt.
Exp Lung Res. 2017 Feb;43(1):19-28. doi: 10.1080/01902148.2017.1282993. Epub 2017 Feb 22.
Patients receiving noninvasive ventilation (NIV) may benefit from medical aerosol, but most guidance on dosing with different aerosol devices is limited to in-vitro studies. The study was designed to in-vitro, ex-vivo, and in-vivo compare aerosol delivery during bilevel NIV with three types of aerosol generators: metered dose inhaler with AeroChamber-MV spacer (AC), Aerogen Pro vibrating mesh nebulizer (PRO), and Sidestream jet nebulizer (SIDE).
A bilevel ventilator with dry single limb circuit and fixed expiratory port was set in spontaneous mode with initial inspiratory and expiratory pressures of 20 and 5 cmH0, 1:3 inspiratory-expiratory ratio, and 15 breaths.min. Aerosol generators were placed proximal to facial mask of NIV chronic obstructive pulmonary disease (COPD) patients. 1 mL salbutamol nebulizer solution (5 mg/mL) was nebulized using PRO and SIDE. 12MDI doses, containing 100μg salbutamol each, were delivered using AC. In-vitro aerosol fate and aerodynamic droplet characteristics, in-vivo amount of salbutamol excreted 30 mins and pooled up to 24 h post inhalation in urine from 12 COPD patients (as indices of pulmonary deposition and systemic absorption, respectively) and amount of salbutamol deposited on ex-vivo filters (expected inhalable amount) was determined.
The in-vitro, in-vivo and ex-vivo testing showed that PRO had better aerosol delivery compared to SIDE (p < 0.01). However, with smaller nominal dose MDI with AC resulted in similar aerosol delivery to PRO suggesting better aerosol delivery stress on careful attention and proper delivery by health care provider.
These similarities and differences between the three aerosol generators tested suggest that aerosol delivery methods should be carefully chosen or substituted in non-invasive ventilated patients.
接受无创通气（NIV）的患者可能会从医用气雾剂中获益，但大多数关于不同气雾剂装置给药的指导仅限于体外研究。本研究旨在通过体外、离体和体内实验，比较在双水平无创通气期间，使用三种气雾剂发生器（带AeroChamber-MV储雾罐的定量吸入器（AC）、Aerogen Pro振动网式雾化器（PRO）和侧流式喷射雾化器（SIDE））时的气雾剂递送情况。
将一台带有干式单管回路和固定呼气端口的双水平呼吸机设置为自主模式，初始吸气和呼气压力分别为20和5 cmH₂O，吸呼比为1:3，呼吸频率为15次/分钟。将气雾剂发生器放置在慢性阻塞性肺疾病（COPD）患者无创通气面罩的近端。使用PRO和SIDE雾化1 mL沙丁胺醇雾化溶液（5 mg/mL）。使用AC递送12剂定量吸入器剂量，每剂含有100μg沙丁胺醇。测定了12例COPD患者体外气雾剂的命运和空气动力学液滴特征、吸入后30分钟尿中排出的沙丁胺醇体内量以及吸入后24小时内尿液中累积的沙丁胺醇量（分别作为肺部沉积和全身吸收的指标），以及沉积在离体滤器上的沙丁胺醇量（预期可吸入量）。
体外、体内和离体测试表明，与SIDE相比，PRO具有更好的气雾剂递送效果（p < 0.01）。然而，使用较小标称剂量的AC定量吸入器可产生与PRO相似的气雾剂递送效果，这表明医疗保健提供者在仔细关注和正确递送时气雾剂递送效果更佳。
所测试的三种气雾剂发生器之间的这些异同表明，对于无创通气患者，应谨慎选择或替代气雾剂递送方法。
