RT Journal Article
SR Electronic
T1 Bronchodilator Delivery During Simulated Pediatric Noninvasive Ventilation
JF Respiratory Care
FD American Association for Respiratory Care
SP respcare.02171
DO 10.4187/respcare.02171
A1 Cynthia C. White
A1 Dave N Crotwell
A1 Shuijie Shen
A1 John Salyer
A1 Delphine Yung
A1 Robert M DiBlasi
YR 2013
UL http://rc.rcjournal.com/content/early/2013/02/05/respcare.02171.abstract
AB Introduction: Noninvasive Ventilation (NIV) is usually applied using Bi-Level Positive Airway Pressure (Bi-PAP) devices and many of these devices use a single-limb patient circuit with an integrated leak port to purge the circuit of exhaled carbon dioxide. Sometimes, bronchodilator therapy is indicated in pediatric patients. However, there have been no forthcoming studies in the literature describing the optimal nebulizer position, with respect to leak during pediatric NIV. We hypothesized that there were no differences in albuterol delivery with a vibrating mesh nebulizer between three different positions/exhalation leak valve combinations within the patient circuit during simulated pediatric NIV. Methods: A simulated upper airway model was attached to a spontaneously breathing lung model (ASL 5000, Ingmar medical). A noninvasive ventilator equipped with heated wire circuit and heated humidifier was attached to the simulated patient via a pediatric oronasal mask. Albuterol (5 mg) was delivered with vibrating mesh nebulizers and at three different circuit position/leak condition combinations, including: 1) prior to the humidifier and leak valve; 2) between the humidifier and leak valve; and 3) integrated within the mask and after the leak. Albuterol was recovered from a filter and quantified using high-pressure liquid chromatography. Results: Greater Albuterol mass was delivered to the filter with the NIVO® nebulizer integrated into the mask 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 (Position 2) than when placed prior to the humidifier (Position 3, P<0.01). Conclusion: Albuterol delivery during simulated pediatric NIV is affected by the position of the nebulizer in relation to the expiratory leak valve and the distance the nebulizer is placed from the filter. A vibrating mesh nebulizer placed intra mask may provide a better alternative for medication delivery than those previously used during pediatric NIV.