title: Efficiency of bronchodilator aerosol delivery to the lungs from the metered dose inhaler in mechanically ventilated patients. A study comparing four different actuator devices.
abstract: OBJECTIVE
  To compare aerosol delivery to the lungs in ventilated patients from two devices with holding chamber and two devices without holding chamber.
  
  
  METHODS
  A controlled clinical trial with randomization to one of four delivery devices.
  
  
  METHODS
  An academic university-affiliated Canadian ICU.
  
  
  METHODS
  Forty-eight patients undergoing mechanically assisted ventilation for a variety of clinical reasons and each judged to require inhaled bronchodilator therapy by the attending physician.
  
  
  METHODS
  Patients received 4 puffs of fenoterol labeled with technetium 99m pertechnetate delivered by metered-dose inhaler via 1 of the following: A, a 167-ml chamber device; B, a 700-ml chamber device; C, a nonchamber device (A, B, and C, all in the ventilator inspiratory line); and D, a nonchamber device on the end of the endotracheal tube.
  
  
  RESULTS
  One-minute images of the thorax were made by a portable gamma camera at the bedside. Deposition of radioactivity in the lungs (uncorrected for tissue absorption and calculated as a percentage of the radioactivity delivered from 4 puffs) was 5.53 +/- 0.72 (mean +/- 1 SEM), 6.33 +/- 1.16, 1.67 +/- 0.43, and 3.89 +/- 0.52 percent for devices A, B, C, and D, respectively (p = 0.004). Subgroup analysis showed a statistically significant difference in delivery between devices A and C and between devices B and C only.
  
  
  CONCLUSIONS
  There were statistically significant differences between delivery from both chamber devices and the inline nonchamber device, but not between delivery from other devices. Further work will be necessary to determine the effect of device position in the ventilator circuit on aerosol delivery.
authors.affiliation: Department of Medicine, St. Joseph's Hospital, 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: F H
authors.initials: FH
authors.lastname: Turpie
authors.forename: M T
authors.initials: MT
authors.lastname: Newhouse
mesh_terms: D000336:Aerosols; D000368:Aged; D004526:Efficiency; D004867:Equipment Design; D005260:Female; D005280:Fenoterol / Q000008:administration & dosage* / Q000493:pharmacokinetics; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation; D008168:Lung / Q000000981:diagnostic imaging / Q000378:metabolism*; D008297:Male; D009330:Nebulizers and Vaporizers; D011877:Radionuclide Imaging; D012121:Respiration, Artificial; D013670:Sodium Pertechnetate Tc 99m; D013499:Surface Properties; D014139:Tracheostomy / Q000295:instrumentation; D012122:Ventilators, Mechanical
chemical_list: D000336:Aerosols; D005280:Fenoterol; D013670:Sodium Pertechnetate Tc 99m