The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


Cynthia C. White1, Dave N. Crotwell2, Shuijie Shuijie3, Delphine Yung3, John Salyer2, Robert M. DiBlasi2; 1Respiratory Care Division, Cincinatti Children’s Hospital Medical Center, Cincinatti OH, OH; 2Seattle Children’s Hospital, Seattle, WA; 3Seattle Children’s Hospital Research Institute, Seattle, WA

Introduction: Noninvasive respiratory support is commonly used as an alternative to invasive ventilation in pediatric patients with severe respiratory distress due to asthma. Bi-Level Positive Airway Pressure (Bi-PAP) devices use a single circuit for breath delivery with an integrated leak valve to purge the circuit of carbon dioxide. Effective bronchodilator delivery is an important intervention for these patients. There have been no forthcoming studies in the literature describing the optimal nebulizer position, with respect to the leak valve, during pediatric noninvasive ventilation. We hypothesized that there are no differences in albuterol delivery with a vibrating mesh nebulizer between 3 different positions/exhalation leak valve combinations within the patient circuit during simulated pediatric noninvasive ventilation. Methods: A face/airway model was attached to a simulated spontaneously breathing pediatric asthmatic lung model (ASL 5000, Ingmar). A V60 Bi-PAP Ventilator (Phillips Respironics, Carlsbad, CA), equipped with heated wire circuit and, Fisher and Paykel 850 heater was attached to the simulated patient via a oronasal mask. Albuterol (5 mg) was delivered with 3 vibrating mesh nebulizers and at 3 different circuit position/leak condition combinations, including: 1) prior to the humidifier and leak valve; 2) between the humidifier and leak valve; and 3) within the mask and after the leak. The Aerogen Solo nebulizer was used for medication delivery in the first two positions and a new lightweight nebulizer that can be integrated into the patient mask (Aerogen NIVO) was used in for the third. Albuterol was recovered from a filter at each position and quantified using high-pressure liquid chromatography. Results: There was greater Albuterol delivered to the lung model with the NIVO nebulizer placed following the exhalation valve than any other testing condition (p < 0.01). In the conditions where the nebulizer was placed prior to the exhalation leak valve, greater drug delivery was observed when the nebulizer was placed proximal to the mask than when placed prior to the humidifier (p < 0.01). Conclusion: Albuterol delivery during simulated pediatric non-invasive ventilation is affected by the position of the nebulizer in relation to the expiratory leak valve. The Aerogen NIVO nebulizer may provide a better alternative for medication delivery than those previously used during noninvasive ventilation of pediatric patients with asthma. Sponsored Research - NO funding— Only 3 NIVO nebulizers contributed by Trianim