Pelkonen A S, Nikander K, Turpeinen M
Department of Allergic Diseases, Helsinki University Central Hospital, Finland.
Pediatr Pulmonol. 1997 Oct;24(4):282-6. doi: 10.1002/(sici)1099-0496(199710)24:4<282::aid-ppul7>3.0.co;2-m.
To determine the dose of inhaled budesonide suspension in the treatment of preterm infants with ventilator-dependent lung disease, we measured the dose of nebulized budesonide delivered through an endotracheal tube (ETT), using a test lung and filters. The effect of delivering the nebulized aerosol to two different locations in the same ventilatory circuit was evaluated. In addition, a new synchronized jet nebulizer was tested. The median drug delivery to the test lung was 0.3% (range, 0-0.4%) of the nominal dose when the nebulizer activated by continuous gas flow was inserted into the inspiratory line of the circuit. Drug delivery could be increased to 0.7% (range, 0.5-0.8%) by delivering the nebulizer output directly to the ETT. When using the synchronized jet nebulizer, drug delivery was 1.1% (range, 0.8-1.6%). The particle size of aerosol emerging from the ETT was 2.14 microns. The nebulization time with the synchronized nebulizer set-up was 38 min, while the other set-ups delivered an equal volume of solution in 6-7 min. Drug delivery of 0.3-1.1% to the test lung illustrates the problems encountered in aerosol treatment of intubated neonates. We conclude that the delivery of budesonide to the test lung can be increased by delivering the nebulizer output to the ETT directly. Using synchronized nebulization during inspiration only can achieve further increases in drug delivery, and wastage of drug during expiration is decreased. Synchronized nebulization may, therefore, have an important place in the delivery of expensive aerosolized drugs.
为确定吸入布地奈德混悬液治疗依赖呼吸机的早产儿肺部疾病的剂量，我们使用测试肺和过滤器测量了经气管内导管（ETT）输送的雾化布地奈德剂量。评估了在同一通气回路的两个不同位置输送雾化气溶胶的效果。此外，还测试了一种新型同步喷射雾化器。当将由持续气流驱动的雾化器插入回路的吸气管道时，输送至测试肺的药物中位剂量为标称剂量的0.3%（范围为0 - 0.4%）。将雾化器输出直接输送至ETT可使药物输送量增加至0.7%（范围为0.5 - 0.8%）。使用同步喷射雾化器时，药物输送量为1.1%（范围为0.8 - 1.6%）。从ETT出来的气溶胶粒径为2.14微米。同步雾化器设置的雾化时间为38分钟，而其他设置在6 - 7分钟内输送等量溶液。输送至测试肺的药物量为0.3 - 1.1%，这说明了在气管插管新生儿的气溶胶治疗中遇到的问题。我们得出结论，将雾化器输出直接输送至ETT可增加布地奈德向测试肺的输送量。仅在吸气期间使用同步雾化可进一步提高药物输送量，并减少呼气期间的药物浪费。因此，同步雾化在昂贵的雾化药物输送中可能具有重要地位。
