McCarthy Sean D, González Héctor E, Higgins Brendan D
Anaesthesia, School of Medicine, National University of Ireland Galway, H91 TK33 Galway, Ireland.
Lung Biology Group, Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, H91 TK33 Galway, Ireland.
J Pers Med. 2020 May 10;10(2):37. doi: 10.3390/jpm10020037.
Aerosol therapy is a key modality for drug delivery to the lungs of respiratory disease patients. Aerosol therapy improves therapeutic effects by directly targeting diseased lung regions for rapid onset of action, requiring smaller doses than oral or intravenous delivery and minimizing systemic side effects. In order to optimize treatment of critically ill patients, the efficacy of aerosol therapy depends on lung morphology, breathing patterns, aerosol droplet characteristics, disease, mechanical ventilation, pharmacokinetics, and the pharmacodynamics of cell-drug interactions. While aerosol characteristics are influenced by drug formulations and device mechanisms, most other factors are reliant on individual patient variables. This has led to increased efforts towards more personalized therapeutic approaches to optimize pulmonary drug delivery and improve selection of effective drug types for individual patients. Vibrating mesh nebulizers (VMN) are the dominant device in clinical trials involving mechanical ventilation and emerging drugs. In this review, we consider the use of VMN during mechanical ventilation in intensive care units. We aim to link VMN fundamentals to applications in mechanically ventilated patients and look to the future use of VMN in emerging personalized therapeutic drugs.
气溶胶疗法是向呼吸系统疾病患者肺部给药的关键方式。气溶胶疗法通过直接针对患病肺区域实现快速起效，从而提高治疗效果，与口服或静脉给药相比，所需剂量更小，并能将全身副作用降至最低。为了优化重症患者的治疗，气溶胶疗法的疗效取决于肺形态、呼吸模式、气溶胶液滴特性、疾病、机械通气、药代动力学以及细胞 - 药物相互作用的药效学。虽然气溶胶特性受药物制剂和设备机制影响，但大多数其他因素依赖于个体患者变量。这促使人们更加努力地采用更个性化的治疗方法，以优化肺部药物递送并改善针对个体患者的有效药物类型选择。振动网式雾化器（VMN）是涉及机械通气和新型药物的临床试验中的主要设备。在本综述中，我们考虑在重症监护病房机械通气期间使用VMN。我们旨在将VMN的基本原理与机械通气患者的应用联系起来，并展望VMN在新型个性化治疗药物中的未来应用。
