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Research ArticleOriginal Contributions

Albuterol Delivery via Tracheostomy Tube

Christopher M Piccuito and Dean R Hess
Respiratory Care August 2005, 50 (8) 1071-1076;
Christopher M Piccuito
Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts, Hartford Hospital, Hartford, Connecticut.
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Dean R Hess
Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts.
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  • For correspondence: [email protected]
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Abstract

HYPOTHESIS: Albuterol delivery through a tracheostomy tube is affected by device (nebulizer vs metered-dose inhaler), interface (mask vs T-piece), bias flow, and humidification.

METHODS: A lift bar was placed between the chambers of a dual-chambered lung model such that a ventilator triggered simulated spontaneous breathing at a rate of 20 breaths/min, tidal volume of 0.4 L, and inspiratory-expiratory ratio of 1:2. An 8-mm inner diameter cuffed tracheostomy tube was placed through a semi-circular model that simulated a patient's neck. Four conditions of gas flow and humidification were used for the nebulizer experiments: heated aerosol (approximately 30 L/min, approximately 30°C), heated humidity (approximately 30 L/min, approximately 30°C), high flow without added humidity (approximately 30 L/min), or a nebulizer attached to the tracheostomy tube without additional flow. The nebulizer was filled with 4 mL that contained 2.5 mg of albuterol, and operated at 8 L/min. The nebulizer was tested with a T-piece or tracheostomy mask. For the metered-dose inhaler experiments, a spacer was used and actuation of the inhaler (100 μg per actuation) was synchronized with inhalation (4 actuations separated by ≥ 15 s). When the spacer was used without additional flow, a valved T-piece was used with a 1-way valve placed either proximal or distal to the spacer. A filter was attached between the lung model and the distal end of the tracheostomy tube. Albuterol washed from the filter was measured by ultraviolet spectrophotometry.

RESULTS: For the nebulizer, the most efficient delivery was with no flow other than that to power the nebulizer and with a T-piece (p < 0.001). The most efficient method for aerosol delivery was metered-dose inhaler with a valved T-piece and placement of the 1-way valve in the proximal position (p < 0.001). The effect of humidity was unclear from the results of this study.

CONCLUSIONS: Albuterol delivery via tracheostomy was affected by the delivery device (nebulizer vs inhaler), bias gas flow, and the patient interface.

  • aerosol
  • bronchodilator
  • metered-dose inhaler
  • nebulizer
  • tracheostomy

Footnotes

  • Correspondence: Dean R Hess PhD RRT FAARC, Respiratory Care, Massachusetts General Hospital, 55 Fruit Street, Boston MA 02114. E-mail: dhess{at}partners.org.
  • Christopher M Piccuito RRT presented a version of this paper at the 49th International Respiratory Congress, held December 8–11, 2003, in Las Vegas, Nevada.

  • Copyright © 2005 by Daedalus Enterprises Inc.
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Respiratory Care: 50 (8)
Respiratory Care
Vol. 50, Issue 8
1 Aug 2005
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Albuterol Delivery via Tracheostomy Tube
Christopher M Piccuito, Dean R Hess
Respiratory Care Aug 2005, 50 (8) 1071-1076;

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Albuterol Delivery via Tracheostomy Tube
Christopher M Piccuito, Dean R Hess
Respiratory Care Aug 2005, 50 (8) 1071-1076;
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Keywords

  • aerosol
  • bronchodilator
  • metered-dose inhaler
  • nebulizer
  • tracheostomy

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