title: An in vitro evaluation of aerosol delivery through tracheostomy and endotracheal tubes using different interfaces.
abstract: BACKGROUND
  Previous research reporting factors influencing aerosol delivery in intubated patients has been largely focused on the endotracheal tube (ETT) during mechanical ventilation, with little comparative analysis of effect of types of artificial airways and their interfaces on  aerosol delivery during spontaneous breathing. The purpose of this study was to compare aerosol delivery via tracheostomy tube (TT) and ETT, using interfaces such as T-piece, tracheostomy collar, and manual resuscitation bag.
  
  
  METHODS
  A teaching manikin was intubated with either an ETT (8.0  mm inner diameter) and TT (8 mm inner diameter). Both bronchi were connected to a collecting filter, attached to a sinusoidal pump simulating the breathing pattern of a spontaneously breathing adult (tidal volume 450 mL, respiratory rate 20 breaths/min, inspiratory-expiratory ratio 1:2). Albuterol  sulfate (2.5 mg/3 mL) was nebulized through a jet nebulizer, using each airway and interface as appropriate (n = 3). Drug on the filter was eluted and analyzed with spectrophotometry, and expressed as mean percent of loaded dose delivered. Descriptive statistics, the Student t  test, and one-way analysis of variance were applied.
  
  
  RESULTS
  A greater percentage of nominal dose was delivered via TT than ETT with both T-piece (13.79 ± 2.59% vs 9.05 ± 0.70%) and manual resuscitation bag (45.75 ± 1.8% vs 27.23 ± 8.98%, P = .038 and P  = .025, respectively). Use of manual resuscitation bag with both TT and ETT increased lung dose more than 3-fold. Inhaled dose with tracheostomy collar was (6.92 ± 0.81%) less than T-piece with TT (P = .01).
  
  
  CONCLUSIONS
  In this adult model of spontaneous ventilation, aerosol  therapy through ETT was less efficient than TT, while the manual resuscitation bag was more efficient than T-piece or tracheostomy collar.
authors.affiliation: Division of Respiratory Therapy, Georgia State University, Atlanta, GA, USA. arzuari@hotmail.com
authors.forename: Arzu
authors.initials: A
authors.lastname: Ari
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Harwood
authors.forename: Meryl M
authors.initials: MM
authors.lastname: Sheard
authors.forename: James B
authors.initials: JB
authors.lastname: Fink
mesh_terms: D000280:Administration, Inhalation; D000336:Aerosols / Q000008:administration & dosage*; D000420:Albuterol / Q000008:administration & dosage; D006801:Humans; D007442:Intubation, Intratracheal; D008348:Manikins; D009330:Nebulizers and Vaporizers; D012121:Respiration, Artificial / Q000379:methods*; D014139:Tracheostomy
chemical_list: D000336:Aerosols; D000420:Albuterol