The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


Jan Mazela2, Timothy J. Gregory1, Christopher Henderson1, Krzysztof Chmura2, Maksymilian Kulza3, Ewa Florek3, Russell G. Clayton1; 1Discovery Laboratories, Inc., Warrington, PA; 2Neonatology, Poznan University of Medical Sciences, Poznan, Poland; 3Laboratory of Environmental Toxicology, Poznan University of Medical Sciences, Poznan, Poland

Background: Aerosolized medication delivery to patients receiving ventilatory support is improved by optimizing placement of aerosol flow within the ventilator circuit. Currently, aerosol entrainment within the ventilator circuit is achieved either by placement of the nebulizer within the inspiratory arm of the circuit or introducing the aerosol between the wye connector and patient interface. A novel technology has been developed to improve the delivery of aerosolized medications to neonates receiving ventilatory support. This technology includes a proprietary aerosol delivery adaptor designed to separate aerosol flow from the ventilator bias flow. Objective: To compare the dose of aerosolized albuterol sulfate delivered to an artificial lung under various ventilator settings using a novel adaptor versus standard of care. Design/Methods: We assembled a neonatal testing system utilizing a Draeger Babylog(R) VN 500 ventilator, neonatal ventilator circuit, and test lung/lung simulator. TwinStar8 HME low volume filters were placed distal to the wye connector or novel adaptor and proximal to the test lung. Albuterol sulfate (0.5mg/mL) was aerosolized for 5 minutes at a flow of 2L/min of air using a Misty Finity(R) nebulizer. Five replicate filters were exposed to aerosolized albuterol at various ventilator settings (Table 1) using either the novel adaptor or a standard wye connector provided with the neonatal circuit. Emitted dose of the nebulizer was determined by exposing 3 filters to the aerosolized albuterol. Filters were collected, extracted and albuterol quantified using high performance liquid chromatography. Results: The emitted dose was 102.8 µg over the 5 minute aerosol period. The doses of aerosolized albuterol delivered during intermittent mechanical ventilation and CPAP are presented in Table 1. Only filters with albuterol levels at or above the assay limit of detection (< 0.28 µg) were included in the statistical analyses (Table 1). Use of the novel adaptor resulted in a significant increase in albuterol delivery of 6- to 14-fold, depending on ventilator conditions. Conclusions: In this in vitro neonatal ventilation model, there was a significant increase in the delivery of aerosolized albuterol under all ventilatory conditions when using the novel adaptor compared with the standard wye connector. Use of this novel adaptor in infants receiving positive pressure ventilatory support may improve the delivery of aerosolized medications.
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Table 1