The Science Journal of the American Association for Respiratory Care

1997 OPEN FORUM Abstracts

EFFECT OF ONE-WAY VALVES ON ALBUTEROL DELIVERY FROM A HEART NEBULIZER DURING CMV

Terri Zinis, RRT, Ellen Keating, RRT, Charlie Vanderwharf, RRT, Patrick Fahey, MD, Jim Fink, RRT. Div of Pulm and Crit Care Med and Respiratory Care Service, Loyola Univ Chicago, Stritch School of Medicine, Maywood IL.

Patients with acute severe airway obstruction commonly require aerosolized bronchodilators for relief. Continuous nebulization of albuterol with large volume continuous nebulizers has been advocated for patients during continuous mechanical ventilation (CMV), with little available data to determine the best method of delivery. The use of a one-way valve between the nebulizer and the inspiratory limb of the ventilator circuit serves to isolate the compressible volume of the nebulizer from the ventilator, but the impact on aerosol delivery to the lung has not been described. We compared aerosol delivery with a pneumatic nebulizer (HEART) during CMV with and without a one way valve to a tracheobronchial model under dry and wet conditions. For each experiment, we administered albuterol sulfate (40 mg) with 0.9% NaCl (72 ml) from a HEART nebulizer driven with O_{2} at 10L/min to a tracheobronchial model. (n=3). Drug was captured on filters and measured by spectrophotometry. Delivery of albuterol to the lower respiratory tract was greater without the one-way valve in both dry (420±55(SD) µg without, 244.5±4µg with; p < 0.037 ANOVA) and heated/humidified (wet) conditions (244.5±3µg without, 90.8±12µg with; p < 0.008). Under wet conditions we found no difference between standard and heated wire circuits. The reduction in compressible volume was < 60ml. In conclusion, when using a HEART nebulizer for continuous nebulization during mechanical ventilation, the use of a one-way valve between the nebulizer and the ventilator circuit markedly reduced delivery of drug to the lower respiratory tract.

Veterans Administration Research Service

OF-97-178

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