The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

AN IMPROVED DEVICE AND PATIENT INTERFACE FOR DELIVERING AEROSOLIZED MEDICATIONS TO PATIENTS WITH TRACHEOTOMIES.


Michael McPeck BS RRT FAARC. Healthline Aerosol Medicine, Baldwin Park CA.



BACKGROUND: Aerosolized drug delivery to spontaneously breathing patients with tracheotomies occurs in both hospital and skilled nursing facility settings. A common method for interfacing a SVN to a trach tube involves connecting the outlet of the SVN Tee to a trach collar (TC) with a length of 22 mm corrugated tubing. Due to the "openness" of the TC, the effectiveness of medication delivery by this method is questionable. The Medicator® Maximizer high-efficiency aerosol delivery system is usually used with a mouthpiece or mask as the patient interface, but the addition of a simple 15 mm ID adapter to the Medicator allows it to be directly interfaced to a trach (or endotracheal) tube.

STUDY QUESTIONS:
How much aerosol is typically delivered via a Tee neb connected to a trach collar? Does the Medicator® aerosol delivery system improve aerosol drug delivery with a direct connection to the trach tube?

METHODS:
We performed bench testing with an AirLife "MistyMax 10" SVN loaded with 3 mL of radiolabeled (99mTc) unit-dose albuterol (2.5 mg in 3 mL 0.9% NaCl) for each run. A piston ventilator was used to create a simulated adult breathing pattern (VT = 600 mL; f = 12 BPM; I:E 1:2) to draw aerosol during inspiration into a HEPA filter connected to the distal end of a #8 Shiley trach tube that had been inserted into the neck of a Styrofoam "wig head." A trach collar was positioned over the trach tube opening for the Tee/TC setup. The SVN was placed first on a Tee setup and then on a Medicator setup and duplicate runs were performed for each device/interface combination: Tee/TC vs. Medicator/Direct. Each setup was run in duplicate for 9 minutes and HEPA filters were measured in a radioisotope counter to determine the Inhaled Mass fraction (radioactivity on filter / radioactivity of initial nebulizer charge). Mass of albuterol (mg) delivered to the HEPA filter was determined by multiplying the Inhaled Mass fraction by 2.5 mg (the mass of albuterol initially placed in the SVN). By using the same SVN on each setup, differences in results reflect the performance of the delivery systems and the type of trach tube interface.

RESULTS
: The Inhaled Mass for the Tee/TC interface (mean ±SD) was 0.06 ±0.01 mg of albuterol and, for the Medicator/Direct interface was 0.38 ±0.04 mg of albuterol. The inhaled mass of albuterol for the Medicator/Direct interface is similar to the amount of albuterol delivery that would ordinarily be inhaled through a mouthpiece by a spontaneously breathing adult.

CONCLUSION:
The Medicator®, with a direct connection to the trach tube, rendered 6.4 times greater albuterol delivery than with the same nebulizer on a Tee with a trach collar and could be a useful device to improve and guarantee the efficacy of aerosol drug delivery to spontaneously breathing patients with artificial airways.

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