The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

MODIFIED I-NEB FOR THE DELIVERY OF ILOPROST AEROSOL IN CATHETERIZED PATIENTS

Ganesh P. Devendra, Richard A. Krasuski, Robert L. Chatburn; The Cleveland Clinic Foundation, Cleveland, OH

The I-Neb Automated Aerosol Device (AAD) (Respironics, Cedar Grove, NJ) is the only FDA approved nebulizer for the administration of Iloprost (Ventavis, Cotherix, San Francisco, CA) in the treatment of pulmonary arterial hypertension. The I-Neb is a hand-held vibrating mesh nebulizer designed for single patient use. Furthermore the I-Neb will only deliver drug when held in a horizontal position. This design limits the administration of Iloprost as such: (i) clinical trials with Iloprost require purchasing an I-neb for each participating patient and (ii) the I-Neb will not work for catheterized patients who are always supine. The purpose of this study was to evaluate a circuit to filter exhaled gas and allow reuse of the I-Neb for multiple patients. METHODS: A filter circuit was constructed using a valve from the Circulaire nebulizer (Westmed, Tucson, AZ), Figure 1. The circuit directed exhaled air through a nonconductive bacterial/viral filter (Cardinal Health; McGaw Park, IL) and back to the I-neb. The I-Neb requires feedback from inhalation and exhalation to function properly as an adaptive device. Ventilation was simulated with an ASL 5000 (Ingmar Medical Inc, Pittsburgh, PA) with frequency = 15 breaths/min, tidal volume = 500 mL, sinusoidal flow pattern. Inhaled aerosol was estimated as the change in mass of a HEPA filter placed between the circuit and the ASL 5000. Normal saline (2 mL) was nebulized and captured on the HEPA filter. Measurements were repeated in triplicate. Mean inhaled aerosol with and without the circuit was compared with t-test, significance at P < 0.05. RESULTS: Nebulization time was approximately 10 minutes. The mean inhaled aerosol of the unmodified I-Neb was 0.32 ± 0.01 g. The inhaled aerosol with the filter circuit decreased to 0.29 ± 0.02 g (P = 0.03). CONCLUSIONS: These data show that the addition of a check valve and 18 inches of plastic tubing to the I-Neb reduced aerosol delivery by a clinically negligible amount. This suggests that the I-Neb AAD may be modified for administration of Iloprost in the cath lab and may have utility in future clinical trials. Sponsored Research - None

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