Moustafa Islam O F, Ali Mohammed R A-A, Al Hallag Moataz, Rabea Hoda, Fink James B, Dailey Patricia, Abdelrahim Mohamed E A
Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt; Clinical Pharmacist Department, Saudi German Hospital SGH, Cairo, Egypt.
Pharmacology and Toxicology Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt.
Heart Lung. 2017 Nov-Dec;46(6):464-467. doi: 10.1016/j.hrtlng.2017.08.004. Epub 2017 Sep 4.
During mechanical ventilation medical aerosol delivery has been reported to be upto two fold greater with dry inhaled gas than with heated humidity. Urine levels at 0.5 h post dose (URSAL0.5%) has been confirmed as an index of lung deposition and 24 h (URSAL24%) as index of systemic absorption. Our aim was to determine the effect of humidification and aerosol device type on drug delivery to ventilated patients using urine levels.
In a randomized crossover design, 36 (18female) mechanically ventilated patients were assigned to one of three groups. Groups 1 and 2 received 5000 μg salbutamol using vibrating mesh (VM) and jet nebulizers (JN), respectively, while group 3 received 1600 μg (16 puffs) of salbutamol via metered dose inhaler with AeroChamber Vent (MDI-AV). All devices were placed in the inspiratory limb of ventilator downstream from the humidifier. Each subject received aerosol with and without humidity at >24 h intervals with >12 h washout periods between salbutamol doses. Patients voided urine 15 min before each study dose and urine samples were collected at 0.5 h post dosing and pooled for the next 24 h.
The MDI-AV and VM resulted in a higher percentage of urinary salbutamol levels compared to the JN (p < 0.05). Urine levels were similar between humidity and dry conditions.
Our findings suggest that in-vitro reports overestimate the impact of dry vs. heated humidified conditions on the delivery of aerosol during invasive mechanical ventilation.
据报道，在机械通气期间，使用干燥吸入气体进行医用气雾剂给药的量比使用加热湿化气体时多两倍。给药后0.5小时的尿药水平（URSAL0.5%）已被确认为肺部沉积指标，24小时的尿药水平（URSAL24%）作为全身吸收指标。我们的目的是通过尿药水平来确定湿化和雾化装置类型对机械通气患者药物递送的影响。
采用随机交叉设计，将36例（18例女性）机械通气患者分为三组。第1组和第2组分别使用振动筛网雾化器（VM）和喷射雾化器（JN）给予5000μg沙丁胺醇，而第3组通过带储雾罐的定量吸入器（MDI-AV）给予1600μg（16喷）沙丁胺醇。所有装置均置于呼吸机吸气支中加湿器下游。每个受试者在间隔>24小时且沙丁胺醇剂量之间有>12小时洗脱期的情况下，分别接受有湿化和无湿化的气雾剂。患者在每次研究剂量前15分钟排尿，给药后0.5小时收集尿样，并合并接下来24小时的尿样。
与JN相比，MDI-AV和VM导致尿中沙丁胺醇水平的百分比更高（p<0.05）。湿化和干燥条件下的尿药水平相似。
我们的研究结果表明，体外报告高估了在有创机械通气期间干燥与加热湿化条件对气雾剂递送的影响。
