2003 OPEN FORUM Abstracts
BABY DON'T CRY: IN VITRO COMPARISON OF " BABY'S BREATH" AEROSOL DELIVERY HOOD VS. FACE MASK OR BLOW-BY USING THE " SAINT" INFANT UPPER AIRWAY MODEL AND "AERONEB GO" VS T-PIECE NEBULIZER
Bert Kesser, RRT, David Geller, MD. Nemours Children's Clinic, Orlando, Florida. Israel Amirav, MD. Rebecca Sieff Hospital, Safed, Israel; James Fink, RRT, FAARC, Aerogen, Inc. Mountain View, CA.
Background: Delivery of aerosolized medication to infants and young children remains challenging, inefficient, and frustrating for caregivers and parents alike. Conventional methods include nebulizer with close-fitting face mask or blow-by. Scintigraphy studies show much better lung deposition in quietly breathing infants than agitated or crying ones. The Baby's Breath system is an open hood with a funnel device designed to passively direct aerosolized drug to infants, thereby avoiding the fussiness associated with using a tight fitting mask. METHOD: We measured delivery of unit dose albuterol (2.5 mg in 3ml) through an infant upper airway model (SAINT) using a simulated 9-mo-old breathing pattern. We compared the Baby's Breath hood (with and without attached aerosol funnel) to an aerosol face mask (AFM) held tight to the face, and with the mask held at 2, 4, and 6 cm from the face. Nebulizers used for these studies were the Vixone (Westmed) jet nebulizer and the Aeroneb Go (Aerogen), which uses an electronic micropump technology (OnQT). "Lung dose" of drug was captured on a filter placed distal to the sub-glottic region of the airway model. Duration of nebulization, upper airway dose, and lung dose were measured.
RESULTS: The Aeroneb Go with Baby's Breath hood and funnel delivered a greater lung dose of albuterol than the Aeroneb Go delivered into a hood without the funnel, or with a close-fitting face mask (89 ± 21 vs. 39 ± 5 vs. 19 ± 7 mcg). The jet nebulizer (Vixone) and close-fitting mask had greater lung dose (62 ± 12 mcg) than blow-by, with lung dose decreased by 35%, 47%, and 69% moving the mask 2, 4 and 6 cm away from the face. Delivery times were similar between nebulizers at 5-6 minutes.
Conclusions: Highest lung delivery was achieved with the Aeroneb Go and Baby's Breath system. Blow-by therapy with a mask was less efficient and diminishes as the distance from the device to the nose is increased. Aeroneb Go with Baby's Breath may be better tolerated by infants and is a viable alternative to a close-fitting face mask.