2010 OPEN FORUM Abstracts
ALBUTEROL DELIVERY BY 3 DIFFERENT NEBULIZERS PLACED IN 4 DIFFERENT POSITIONS IN A HEATED WIRE VENTILATOR CIRCUIT UTILIZING A PEDIATRIC VENTILATOR IN-VITRO MODEL.
Randy Willis1, Ariel Berlinski2,3; 1RCS, Arkansas Childrens Hospital, Little Rock, AR; 2Dept of Pediatrics, Pulmonary, UAMS, Little Rock, AR; 3Pediatric Aerosol Research Laboratory, ACHRI, Little Rock, AR
Background: Aerosol delivery during mechanical ventilation depends on several factors. We use heated wire ventilator circuits (HWVC) (Fisher-Paykel, Auckland, NZ) with our ventilators (Servo~i, Maquet, Solna, Sweden). Different inline aerosol delivery technologies are available in the market. We compared albuterol output from 3 different nebulizers placed inline in 4 different positions in a HWVC utilizing pediatric ventilator settings. Methods: 5 units of continuously operated jet (HUDSON RCI UP-DRAFT II® Opti-neb Nebulizer, Teleflex Medical, Research Triangle Park, NC) (JET), ultrasonic (Maquet Ultrasonic nebulizer, model N06302595E400E, Solna, Sweeden) (ULTRA), and vibrating mesh (Aerogen Solo, Aerogen Ltd, Galway, Ireland) (VIBMESH) nebulizers were studied. Jet nebulizers were operated at 6 L/min with central oxygen for 5 minutes. Ultrasonic and vibrating mesh nebulizers were operated for 15 min. Five mg/3.5mL of albuterol sulfate were used for all nebulizers. The ventilator was operated in PRVC mode, VT 200 mL, RR 20, PEEP 5 cm H2O, FiO2 0.4, IT 0.75 seconds, inspiratory rise 0.15 seconds, flow trigger 3 and heater 37 ± 1.5 C. The HWVC was connected to a 5.5 cuffed ETT followed by a lung model with a deposition filter interposed between them. VT was adjusted when jet nebulizer was tested. The nebulizers were placed at the following positions: Wye (@Y), right after the humidifier (@H), at the ventilator (@V), and 30 cm before the wye (@30). Albuterol was measured by spectrophotometry at 276 nm. Statistical analysis was performed with ANOVA followed by Tukey. A p value of 0.05 was considered significant. Results: (see table, mean ± SD). Position (within devices comparison): JET and VIBMESH had higher output @H &@V than @Y & @30 (p < 0.01). ULTRA had higher output @H than @Y & @30. Devices (between devices comparison): The highest output was given by VIBMESH followed by ULTRA then followed by JET (p < 0.01) when placed @H and @Y. ULTRA had equal output to JET but smaller output than VIBMESH when placed @V. VIBMESH had higher output than JET when @30 (P < 0.05). Conclusions: Placing the nebulizer inline at the ventilator and right after the humidifier provided higher albuterol output compared to the wye and 30 cm before the wye in a pediatric ventilator model. Vibrating mesh nebulizer had the highest albuterol output at any tested position. Sponsored Research - None