体外比较高频辅助气道清除装置与集成雾化器的气溶胶输送。
In Vitro Comparison of Aerosol Delivery in High-Frequency Assisted Airway Clearance Devices With Integrated Nebulizers.
机构信息
Center for Respiratory Biology and Therapeutics, Seattle Children's Research Institute, Seattle, Washington. Respiratory Therapy Department, Seattle Children's Hospital, Seattle, Washington.
Center for Respiratory Biology and Therapeutics, Seattle Children's Research Institute, Seattle, Washington.
出版信息
Respir Care. 2024 Sep 26;69(10):1221-1230. doi: 10.4187/respcare.11988.
BACKGROUND
High-frequency assisted airway clearance systems combine positive expiratory pressure or oscillatory positive airway pressure with integrated nebulizers to improve the delivery of aerosols and assist with airway clearance. This aerosol study evaluated lung delivery efficiency during positive expiratory pressure and oscillatory positive airway pressure therapy of 2 high-frequency assisted airway clearance/nebulizer systems.
METHODS
Aerosol delivery was evaluated during positive expiratory pressure therapy of 10 cm HO and oscillatory positive airway pressure therapy of 20 cm HO with the BiWaze Clear and the Volara high-frequency assisted airway clearance/nebulizer systems. The handset and nebulizer were attached to an anatomic upper-airway model via a mouthpiece and placed into a plethysmograph. A tracheal filter was placed to capture the inhaled aerosol. A vacuum filter entrained fugitive aerosols from the plethysmograph. After nebulization of technetium in 3.0 mL normal saline solution, the components were scanned by using scintigraphy and the decay-corrected radiation counts were referenced to the initial nebulizer technetium charges.
RESULTS
Aerosol delivery during positive expiratory pressure therapy of 10 cm HO resulted in higher lung deposition with the BiWaze Clear versus the Volara (28 vs 6.2%; < .001; 95% CI 16.5-27.7), and higher fugitive losses (23.7 vs 2.8%; = .004) and nebulizer losses (55 vs 3.3%; < .001) with the Volara than with the BiWaze Clear. Aerosol delivery during oscillatory positive airway pressure of 20 cm HO resulted in a higher lung deposition with the BiWaze Clear versus the Volara (16.3 vs 7.3%; = .005; 95% CI 3.3-15) and higher fugitive (22.3 vs 3.8%; = .02) and nebulizer (58.8 vs 7.2%; = .004) losses with the Volara. There were no differences at the other locations during testing.
CONCLUSIONS
The BiWaze Clear system showed greater delivery efficiency than did the Volara during positive expiratory pressure and oscillatory positive airway pressure. The high residual nebulizer dose and fugitive aerosol losses through the handset leak valve contributed to the lower delivery efficiency observed with the Volara. The nebulizer type, circuit design, and handset are important factors when targeting effective aerosol delivery to the lungs with high-frequency assisted airway clearance therapy.
背景
高频辅助气道清除系统将正呼气压力或振荡正气道压力与集成雾化器结合使用，以提高气溶胶的输送并辅助气道清除。这项气溶胶研究评估了两种高频辅助气道清除/雾化器系统在正呼气压力和振荡正气道压力治疗期间的肺部输送效率。
方法
在 BiWaze Clear 和 Volara 高频辅助气道清除/雾化器系统中，评估了 10cmH2O 正呼气压力治疗和 20cmH2O 振荡正气道压力治疗期间的气溶胶输送。将手机和雾化器通过接口连接到解剖上的上呼吸道模型，并放置在体积描记器中。放置一个气管过滤器来捕获吸入的气溶胶。一个真空过滤器从体积描记器中捕获逃逸的气溶胶。在 3.0ml 生理盐水溶液中雾化锝后，通过闪烁扫描对成分进行扫描，并将校正后的辐射计数与初始雾化器锝电荷进行参考。
结果
在 10cmH2O 的正呼气压力治疗期间，与 Volara 相比，BiWaze Clear 导致更高的肺部沉积（28%比 6.2%；<0.001；95%CI 16.5-27.7），以及更高的逃逸损失（23.7%比 2.8%；=0.004）和雾化器损失（55%比 3.3%；<0.001）。在 20cmH2O 的振荡正气道压力下，与 Volara 相比，BiWaze Clear 导致更高的肺部沉积（16.3%比 7.3%；=0.005；95%CI 3.3-15）和更高的逃逸（22.3%比 3.8%；=0.02）和雾化器（58.8%比 7.2%；=0.004）损失。在测试的其他位置没有差异。
结论
与 Volara 相比，BiWaze Clear 系统在正呼气压力和振荡正气道压力期间表现出更高的输送效率。高残留的雾化器剂量和通过手机泄漏阀的逃逸气溶胶损失导致了在 Volara 中观察到的较低的输送效率。当目标是通过高频辅助气道清除治疗将有效的气溶胶输送到肺部时，雾化器类型、电路设计和手机是重要因素。
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