The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


Michael McPeck; McPeck Consulting Services, Huntington Beach, CA

BACKGROUND. To facilitate aerosol drug delivery during NIV with an oro-nasal face mask, and single-limb circuit with intentional leak port, a specialized mask elbow, with a port for an electronic mesh nebulizer (NIVO/Pro-X, Philips Respironics), has been developed. Because SVNs are relatively inefficient and add extraneous gas flow to the circuit,this study sought to determine if the NIVO, interfaced between the mask and the leak port, would provide greater aerosol delivery than the SVN. METHODS. A face model/respiration simulator was ventilated via an oro-nasal mask with a Philips Respironics V60 bilevel ventilator at 3 different settings: CPAP 5, bi-level10/5 and bi-level 15/8 cmH2O. 3 mL of Technetium (99mTc)-radiolabeled 0.083% albuterol inhalation solution (2.5 mg) was nebulized via SVN powered by air at 8 L/min and with the NIVO vibrating mesh nebulizer. In separate test runs, the SVN and NIVO were connected to the mask elbow, effectively placing them between the mask and the leak port of the patient circuit. Nebulizers and HEPA filters were measured in a radioisotope calibrator to determine radioactivity. Filters connected to the ‘mouth’ of the face model were analyzed for captured 99mTc-albuterol to determine Inhaled Aerosol (IA), which was plotted against the treatment time. RESULTS. All test runs were done in duplicate; averaged and compared by t-test. For all 3 NIV settings IA was greater with the NIVO than the SVN: 14.6% vs 7.2% for CPAP 5 cmH2O (p=0.061), 14.3% vs 6.4% for bi-bevel of 10/5 cmH2O (p=0.094), and 15.4% vs 3.4% for bi-level of 15/8 cmH2O (p=0.004). The IA was delivered in a mean of 4.7 mins with the NIVO vs 6.7 mins for the SVN. Mean (±SD) Retained Charge was 54.9 (±3.2)% for the SVN and was 3.8 (±0.5)% for the NIVO indicating that a much greater mass of the drug with which the device had been charged was actually emitted and not left behind in the nebulizer after it ceased generating aerosol. CONCLUSION. These data confirm the hypothesis and support the use of the Philips Respironics NIVO electronic mesh nebulizer for aerosol drug delivery during NIV. Compared to an SVN, when charged with 2.5 mg/3 mL of albuterol, the NIVO interfaced to the NIV mask elbow delivered a greater drug mass in all 3 configurations studied. {Mr McPeck was Respiratory Care Director at Long Beach Memorial Medical Center, Long Beach CA, when he commenced this study. Study was organized and facilitated by Strategic Dynamics, Inc., Scottsdale, AZ}. Sponsored Research - I was subcontracted by Strategic Dynamics, Inc. to design and conduct a study on behalf of Philips Respironics to determine the aerosol delivery performance of their mesh nebulizer attachment for one the NIV masks. I billed my time and aerosol laboratory supply costs to Strategic Dynamics.