In vitro evaluation of bronchodilator drug delivery by jet nebulization during pediatric mechanical ventilation.
OBJECTIVE
To determine the influence of jet nebulizer brands and nebulization mode on albuterol delivery in a mechanically ventilated pediatric lung model.


METHODS
In vitro, laboratory study.


METHODS
Research laboratory of a university hospital.


METHODS
Using albuterol as a marker, six jet nebulizers (Microneb NA420, Sidestream, Acorn II, Cirrus, Upmist, Micro Mist) were tested in four nebulization modes in a bench model mimicking the ventilatory pattern of a 10-kg infant (Galileo ventilator, Hamilton Medical). The amounts of albuterol deposited on the inspiratory filters at the end of the endotracheal tube were determined, as well as the pressure, flow profiles, and particle size distribution of the jet nebulizers.


RESULTS
Pooling the data of the six jet nebulizer brands (n = 30) indicated that intermittent nebulization during the expiratory phase was more efficient (6.5 +/- 2.5% of the initial dose, p < .001) than intermittent nebulization during the inspiratory phase (1.9 +/- 1.2%) and continuous nebulization with air from the ventilator (4.0 +/- 1.5%) or from an external source (4.2 +/- 1.4%). The particle size distribution at 6 L x min(-1) was between 2.81 and 3.30 microm.


CONCLUSIONS
In our in vitro pediatric lung model, the quantity of inhaled drug was low. Jet nebulizer brands and nebulization modes significantly affected drug delivery, and in vitro models designed for adults cannot be extrapolated to infants.
Department of Pharmacy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Ermindo.Di-Paolo@chuv.hospvd.ch
Ermindo R
ER
Di Paolo
André
A
Pannatier
Jacques
J
Cotting
D000336:Aerosols; D000420:Albuterol / Q000008:administration & dosage*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D006801:Humans; D066298:In Vitro Techniques; D007223:Infant; D009330:Nebulizers and Vaporizers; D010316:Particle Size; D012121:Respiration, Artificial; D013673:Technology Assessment, Biomedical
D000336:Aerosols; D001993:Bronchodilator Agents; D000420:Albuterol