The Science Journal of the American Association for Respiratory Care

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.


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