title: Pressurized aerosol versus jet aerosol delivery to mechanically ventilated patients. Comparison of dose to the lungs.
abstract: The purpose of this study was to compare deposition of aerosol to the lung from a metered-dose inhaler (MDI) and aerosol holding chamber and from a jet nebulizer in ventilator-dependent patients. Twenty-one patients were entered into the study, all receiving assisted ventilation and inhaled bronchodilators because of airflow limitation. The average age was 68 yr; there were 10 men and 11 women. The patients were randomized to receive either 4 puffs (800 micrograms) of radiolabeled fenoterol by MDI of 1.75 ml (1,750 micrograms) of radiolabeled fenoterol solution by nebulizer. Imaging of lung fields was made by a portable scintillation camera at 5-min intervals during the study. Results showed that 20 patients completed the study, 9 receiving fenoterol by MDI, and 11 by jet nebulizer. Four were excluded from analysis because of previous pneumonectomy, two from each group. Lung deposition measured as a percent of given dose from either system was 5.65 +/- 1.09 (mean +/- SEM) for MDI plus extension chamber and 1.22 +/- 0.35 for jet nebulizer (p less than 0.001). Therefore, this trial shows significantly greater efficiency of aerosol deposition to the lung in ventilator-dependent patients when using an MDI plus aerosol holding chamber than when using a jet nebulizer.
authors.affiliation: Department of Medicine, St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada.
authors.forename: H D
authors.initials: HD
authors.lastname: Fuller
authors.forename: M B
authors.initials: MB
authors.lastname: Dolovich
authors.forename: G
authors.initials: G
authors.lastname: Posmituck
authors.forename: W W
authors.initials: WW
authors.lastname: Pack
authors.forename: M T
authors.initials: MT
authors.lastname: Newhouse
mesh_terms: D000336:Aerosols; D000368:Aged; D004305:Dose-Response Relationship, Drug; D004867:Equipment Design; D005260:Female; D005280:Fenoterol / Q000008:administration & dosage; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation / Q000295:instrumentation*; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D009330:Nebulizers and Vaporizers; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D011877:Radionuclide Imaging; D016032:Randomized Controlled Trials as Topic; D013670:Sodium Pertechnetate Tc 99m; D013671:Technetium Tc 99m Sulfur Colloid
chemical_list: D000336:Aerosols; D005280:Fenoterol; D013671:Technetium Tc 99m Sulfur Colloid; D013670:Sodium Pertechnetate Tc 99m