RT Journal Article
SR Electronic
T1 Characterization of Ribavirin Aerosol With Small Particle Aerosol Generator and Vibrating Mesh Micropump Aerosol Technologies
JF Respiratory Care
FD American Association for Respiratory Care
SP 577
OP 585
DO 10.4187/respcare.04383
VO 61
IS 5
A1 Brian K Walsh
A1 Peter Betit
A1 James B Fink
A1 Luis M Pereira
A1 John Arnold
YR 2016
UL http://rc.rcjournal.com/content/61/5/577.abstract
AB BACKGROUND: Ribavirin is an antiviral drug that can be administered by inhalation. Despite advancements in the oral delivery of this medication, there has been a renewed interested in delivering ribavirin via the pulmonary system. Although data are not conclusive that inhaled ribavirin improves outcomes, we set out to determine whether delivery by a newer generation nebulizer, the vibrating mesh micropump, was as effective as the recommended small-particle aerosol generator system.METHODS: We compared the physicochemical makeup and concentrations of ribavirin before and after nebulization with 0.9% NaCl and sterile water. An Andersen cascade impactor was used to determine particle size distribution and mass median aerodynamic diameter, and an absolute filter was used to measure total aerosol emitted output and inhaled dose during mechanical ventilation and spontaneous breathing. Ribavirin was analyzed and quantified using high-performance liquid chromatography with tandem mass spectrometric detection.RESULTS: Ribavirin was found to be stable in both 0.9% aqueous NaCl and sterile water with an r2 value of 0.96 and identical coefficients of variation with no difference in drug concentration before and after nebulization with the vibrating mesh micropump. The small-particle aerosol generator produced a smaller mass median aerodynamic diameter (1.84 μm) than the vibrating mesh micropump (3.63 μm, P = .02); however, there was no significant difference in the proportion of drug mass in the 0.7–4.7-μm particle range. Total drug delivery was similar with the small-particle aerosol generator and vibrating mesh micropump in both spontaneously breathing (P = .77) and mechanical ventilation (P = .48) models.CONCLUSIONS: The vibrating mesh micropump nebulizer may provide an effective alternative to the small-particle aerosol generator in administration of ribavirin using NaCl or sterile water, both on and off the ventilator. Further clinical studies are needed to compare efficacy.