The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

MININEB THERAPY VIA NEONATAL VENTILATOR

Stephen G. Staib,RRT and Nicole Perrimon, CRT Respiratory Care Services Hahnemann University Hospital Broad and Vine Sts. Philadelphia, PA  19102

BACKGROUND;   While mininebulizer therapy via adult ventilators remains controversial, we have physicians who order mininebulizers via neonatal ventilators. We decided to find out how much medication was actually reaching the proximal end of the neonatal endotracheal tube.

OBJECTIVE; To determine, by weight and corresponding percentage, how much medication reaches the proximal end of the neonatal endotracheal tube, and how much medication is lost, and where does the lost occur.

MATERIALS; We used the BIRD VIP T ventilator, MEDLINET nebulizer, AIRLIFE ISOTHERMALT nebulizer adaptor, AIRLIFE ISOTHERMALT infant respiratory circuit, INFANTSTART artificial lung, generic heat moisture exchanger-filter, and 5cc normal saline solution for nebulization.

METHOD; We set the ventilator with a inspiratory time of .40 seconds, frequency of 20 BPM, flow rate of 10 LPM, peak inspiratory pressure of 20 CM, a peep of 5 CM, and a Fio2 at 100%, and nebulized the saline for 20 minutes. We connected the nebulizer at the temperature probe or the patient wye and ran the nebulizer at 4 LPM, 6 LPM, and 8 LPM. We weighed the individual parts before and after nebulization on a clinical laboratory scale to produce our results. We ran each flow rate and position ( n=20 each) to verify our results.

RESULTS;
With the nebulizer connected at the temperature probe and the flow meter running at 4 lpm , we measured 37.5 mg. (2.2% of the starting amount of saline) in the artificial lung. At 6 lpm, we measured 38 mg (2.2%). At 8 lpm, we measured 50 mg (2.9%). With the nebulizer connected at the patient wye and the flow meter running at 4 lpm, we measured 80 mg(4.7%) in the artificial lung. At 6 lpm, we measured 140 mg (8.2%). At 8 lpm, we measured 312 mg (18.4 %).

CONCLUSIONS;
As the results shows, the best method for delivery was 8 lpm with the nebulizer connected at the patient wye. Since other studies show that there is a decrease of about 80-90% of medication delivered via a 2.5 or 3.0 mm endotracheal tube, plus our study showing a decreased amount of  medication delivered to the end of the patient wye, very little medication reaches the neonatal patient. We also tried decreasing the ventilator flow , but the increase in delivered volume was 1-2%. We noted that a bolus of medication formed at each right angle turn in the adaptor, tubing, and patient wye, which also caused a reduction of medication toward the patient.


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