title: Effect of continuous positive airway pressure combined to nebulization on lung deposition measured by urinary excretion of amikacin.
abstract: Continuous positive airway pressure (CPAP) is frequently used in patients attending emergency units. Its combination with nebulization is sometimes necessary in those patients presenting with a CPAP dependency.
  
  
  OBJECTIVE
  To compare lung deposition of amikacin delivered by a classical jet nebulizer (SideStream; Medic-Aid; West Sussex, UK) used alone (SST) or coupled to a CPAP device (Boussignac; Vygon; Belgium).
  
  
  METHODS
  Amikacin (1g) was nebulized with both devices in six healthy subjects during 5 min on spontaneous breathing. A 1-week wash-out period between each nebulization was applied. Lung deposition was indirectly assessed by urinary monitoring of excreted amount of amikacin.
  
  
  RESULTS
  Total daily amount of amikacin excreted in the urine was significantly lower with CPAP than with SST (1.97% initial dose versus 4.88% initial dose, p<0.001) with a corresponding mean ratio CPAP/SST of 0.41. The residual amount of amikacin in the nebulizer was higher with CPAP than with SST (607 mg versus 541 mg) but the difference was not significant (p=0.35).
  
  
  CONCLUSIONS
  These data suggest that the amount of amikacin delivered to healthy lungs is 2.5-fold lower with CPAP than with SST for the same nebulization time and that the nebulization time when using CPAP should be increased to reach the same amount of drug delivered with a classical jet nebulizer.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium. Gregory.reychler@clin.ucl.ac.be
authors.forename: Gregory
authors.initials: G
authors.lastname: Reychler
authors.forename: Teresinha
authors.initials: T
authors.lastname: Leal
authors.forename: Jean
authors.initials: J
authors.lastname: Roeseler
authors.forename: Frédéric
authors.initials: F
authors.lastname: Thys
authors.forename: Nicolas
authors.initials: N
authors.lastname: Delvau
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Liistro
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000583:Amikacin / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000652:urine; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000652:urine; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008168:Lung / Q000378:metabolism*; D008297:Male; D009330:Nebulizers and Vaporizers; D013147:Spirometry
chemical_list: D000900:Anti-Bacterial Agents; D000583:Amikacin