PT  - JOURNAL ARTICLE
AU  - Ariel Berlinski
TI  - In-vitro nebulized albuterol delivery in a model of spontaneously breathing children with tracheostomy.
AID  - 10.4187/respcare.02419
DP  - 2013 May 14
TA  - Respiratory Care
PG  - respcare.02419
4099  - http://rc.rcjournal.com/content/early/2013/05/14/respcare.02419.short
4100  - http://rc.rcjournal.com/content/early/2013/05/14/respcare.02419.full
AB  - Background: Nebulized therapy is commonly used in spontaneously breathing tracheostomized patients despite lack of recommended devices and techniques. We compared albuterol dose delivered toa model of spontaneously breathing children with tracheostomy using different nebulizers, tracheostomy tube sizes, inhalation techniques, and breathing patterns. Methods: A tracheostomy model was connected in series to a breathing simulator with a filter interposed. Breathing patterns of a 16 month old and 12-year old child and tracheostomytubes with internal diameters (mm) of 3.5, and 5.5 were used. Albuterol nebulizer solution (2.5 mg/3 ml) was used. A breath enhanced (BEN), a breath actuated (BAN), and a continuously operated nebulizer (CON) wereoperated for 5 minutes and run at 6 L/min with wall air. The latter was tested with different interfaces (T-piece and mask),with an extension tube and operated with and without assisted technique (every breath and every other breath). The amount of albuterol delivered was analyzed via spectrophotometry (276 nm). Particle size distribution was analyzed with a cooled Next Generation Impactor. Results: BEN was more efficient than others. Assisted technique for CON with extension increased albuterol delivery with every other breath (second best device/configuration) being superior to every breath technique. Adding an extension tube increased delivered albuterol. A T-piece was more efficient than a mask. Breathing patterns with larger Vt increased albuterol delivery. Tracheostomy size had less impact on drug delivery. Mass median aerodynamic diameter decreased between 48% and 74% when passing to the tracheostomies.0.8% of the nominal dose was deposited in the tracheostomy tube. Conclusions: The amount of albuterol delivered to a model of spontaneously breathing children with tracheostomyis influence by type of device and its configuration, use of assisted delivery, breathing pattern and tracheostomy size. Aerosols significantly decrease in size after passing through the tracheostomy tube.