2006 OPEN FORUM Abstracts
Does Patient Position During Nebulization Influence Pediatric Aerosol Mask Performance?
Hui-Ling
Lin MS RRT RN,
Ruben D Restrepo MD RRT, Douglas S Gardenhire MS RRT, Joseph L Rau PhD RRT FAARC.
Department of Cardiopulmonary Sciences,
Georgia
State
University
,
Atlanta
GA
Background: The Fish pediatric aerosol mask (Pari,
Monterey
,
CA
) provides greater inhaled drug mass, according to
our previous study.1 However, due to the angle of the adaptor, sputtering
occurred after an average of four minutes of nebulization which caused
inability to set the nebulizer in a perpendicular position. Purpose: To evaluate inhaled drug mass delivery
while using the Fish mask with two different patient positions at three
different distances from the face in a model of a spontaneously breathing
pediatric patient.
Methods: We compared a Misty-Neb nebulizer attached
to the Fish aerosol mask in two patient positions, in an up-right and a 30ยบ
inclined position. Aerosol delivery with each position was measured at 0 cm
(mask directly applied to the face), 1 cm, and 2 cm away from a mannequin face.
Each nebulizer was filled with a 3 mL unit dose of albuterol sulfate and
powered by oxygen at 8 L/min for a total of 5 minutes of nebulization. The
nebulizer was connected to the Active Servo Lung 5000 (IngMar
Medical,
Pittsburgh
,
MA
) to simulate a spontaneously
breathing infant. We measured (1) inhaled mass by collecting the nebulized drug
in a two-way anesthesia filter at the breathing simulator inlet, (2) residual
drug lost in the nebulizer by weighing each nebulizer; empty, after filling,
and after nebulization, (3) estimated drug lost to atmosphere by subtracting
the measured inhaled amount and nebulizer residual amount from the nominal
dose.
Results: There was no
significant difference in the inhaled drug mass between the two positions despite
the different sputtering times (p = 0.764). However, there was a significant
decrease in inhaled drug mass when the mask was placed 1 and 2 cm away from the
face in both positions tested (p = 0.002 and p= 0.001, respectively).
Conclusion: While patient's position may not
affect the inhaled drug mass, the pediatric aerosol mask should fit closely on the
patient's face during nebulization to optimize drug delivery.
| 1. | Lin H, Restrepo RD , Gardenhire DS, Rau JL. An in vitro investigation of nebulized albuterol delivery by pediatric aerosol facemasks to spontaneously breathing infants. Respir Care 2005;11:1550. |