title: Albuterol delivery in an in vitro pediatric ventilator lung model:  comparison of jet, ultrasonic, and mesh nebulizers.
abstract: OBJECTIVE
  To determine the influence of nebulizer types and nebulization modes on bronchodilator 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, three nebulizer types (jet nebulizer, ultrasonic nebulizer, and vibrating-mesh nebulizer) were tested in three nebulization modes in a nonhumidified bench model mimicking the ventilatory pattern of a 10-kg infant. The amounts of albuterol deposited on the inspiratory filters (inhaled drug) at the end of the endotracheal tube, on the expiratory filters, and remaining in the nebulizers or in the ventilator circuit were determined. Particle size distribution of the nebulizers was also measured.
  
  
  RESULTS
  The inhaled drug was 2.8% ± 0.5% for the jet nebulizer, 10.5% ± 2.3% for the ultrasonic nebulizer, and 5.4% ± 2.7% for the vibrating-mesh nebulizer in intermittent nebulization during the inspiratory phase (p < 0.01). The most efficient nebulizer was the vibrating-mesh nebulizer in continuous nebulization (13.3% ± 4.6%, p < 0.01). Depending on the nebulizers, a variable but important part of albuterol was observed as remaining in the nebulizers (jet and ultrasonic nebulizers), or being expired or lost in the ventilator circuit (all nebulizers). Only small particles (range 2.39-2.70 µm) reached the end of the endotracheal tube.
  
  
  CONCLUSIONS
  Important differences between nebulizer types and nebulization modes were seen for albuterol deposition at the end of the endotracheal tube in an in vitro pediatric ventilator-lung model. New aerosol devices, such as ultrasonic and vibrating-mesh nebulizers, were more efficient than the jet nebulizer.
authors.affiliation: 1 Department of Pharmacy, University Hospital (CHUV), Lausanne, Switzerland. 2 School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland. 3 Pediatric Intensive Care Unit, University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Sidler-Moix
authors.forename: Ugo
authors.initials: U
authors.lastname: Dolci
authors.forename: Markoulina
authors.initials: M
authors.lastname: Berger-Gryllaki
authors.forename: André
authors.initials: A
authors.lastname: Pannatier
authors.forename: Jacques
authors.initials: J
authors.lastname: Cotting
authors.forename: Ermindo R
authors.initials: ER
authors.lastname: Di Paolo
mesh_terms: D000336:Aerosols / Q000008:administration & dosage*; D000420:Albuterol / Q000008:administration & dosage*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D016503:Drug Delivery Systems; D006801:Humans; D001239:Inhalation; D008168:Lung; D008422:Materials Testing; D008954:Models, Biological; D009330:Nebulizers and Vaporizers; D010316:Particle Size; D014465:Ultrasonics; D012122:Ventilators, Mechanical; D014732:Vibration
chemical_list: D000336:Aerosols; D001993:Bronchodilator Agents; D000420:Albuterol