In Vitro Comparison of a Vibrating Mesh Nebulizer Operating in Inspiratory Synchronized and Continuous Nebulization Modes During Noninvasive Ventilation.
Backround: Coupling nebulization with noninvasive ventilation (NIV) has been shown to be effective in patients with respiratory diseases. However, a breath-synchronized nebulization option that could potentially improve drug delivery by limiting drug loss during exhalation is currently not available on bilevel ventilators. The aim of this in vitro study was to compare aerosol delivery of amikacin with a vibrating mesh nebulizer coupled to a single-limb circuit bilevel ventilator, using conventional continuous (Conti-Neb) and experimental inspiratory synchronized (Inspi-Neb) nebulization modes.



Using an adult lung bench model of NIV, we tested a vibrating mesh device coupled with a bilevel ventilator in both nebulization modes. Inspi-Neb delivered aerosol only during the whole inspiratory phase, whereas Conti-Neb delivered aerosol continuously. The nebulizer was charged with amikacin solution (250 mg/3 mL) and placed at two different positions: between the lung and exhalation port and between the ventilator and exhalation port. Inhaled, expiratory wasted and circuit lost doses were assessed by residual gravimetric method. Particle size distribution of aerosol delivered at the outlet of the ventilator circuit during both nebulization modes was measured by laser diffraction method.



Regardless of the nebulizer position, Inspi-Neb produced higher inhaled dose (p < 0.01; +6.3% to +16.8% of the nominal dose), lower expiratory wasted dose (p < 0.05; -2.7% to -42.6% of the nominal dose), and greater respirable dose (p < 0.01; +8.4% to +15.2% of the nominal dose) than Conti-Neb. The highest respirable dose was found with the nebulizer placed between the lung and exhalation port (48.7% ± 0.3% of the nominal dose).



During simulated NIV with a single-limb circuit bilevel ventilator, the use of inspiratory synchronized vibrating mesh nebulization improves respirable dose and reduces drug loss of amikacin compared with continuous vibrating mesh nebulization.
1 Western Switzerland University of Applied Sciences-Haute Ecole de Santé Vaud , Filière Physiothérapie, Switzerland .|6 Cliniques Universitaires Saint-Luc, Service de Pneumologie; Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC) , Pôle de Pneumologie, ORL & Dermatologie, Belgium .
Jean-Bernard
JB
Michotte
2 Western Switzerland University of Applied Sciences-Haute Ecole d'Ingénierie et de Gestion du Canton de Vaud , Switzerland .
Enrico
E
Staderini
3 Centre d'Etude des Pathologies Respiratoires, INSERM, UMR 1100, Equipe "aérosolthérapie et biomédicaments à visée respiratoire," Université de Tours , Faculté de Médecine, France .
Deborah
D
Le Pennec
4 Cliniques Universitaires Saint-Luc , Service des soins intensifs, Belgium .
Jonathan
J
Dugernier
2 Western Switzerland University of Applied Sciences-Haute Ecole d'Ingénierie et de Gestion du Canton de Vaud , Switzerland .
Rares
R
Rusu
4 Cliniques Universitaires Saint-Luc , Service des soins intensifs, Belgium .
Jean
J
Roeseler
3 Centre d'Etude des Pathologies Respiratoires, INSERM, UMR 1100, Equipe "aérosolthérapie et biomédicaments à visée respiratoire," Université de Tours , Faculté de Médecine, France .|5 Aerodrug, DTF, Faculty of Medicine, Tours University , France .
Laurent
L
Vecellio
6 Cliniques Universitaires Saint-Luc, Service de Pneumologie; Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC) , Pôle de Pneumologie, ORL & Dermatologie, Belgium .
Giuseppe
G
Liistro
6 Cliniques Universitaires Saint-Luc, Service de Pneumologie; Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC) , Pôle de Pneumologie, ORL & Dermatologie, Belgium .
Grégory
G
Reychler
D000280:Administration, Inhalation; D000328:Adult; D000336:Aerosols; D000583:Amikacin / Q000008:administration & dosage* / Q000737:chemistry; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000737:chemistry; D016503:Drug Delivery Systems / Q000295:instrumentation*; D004867:Equipment Design; D045853:Exhalation; D006801:Humans; D001239:Inhalation; D008168:Lung / Q000033:anatomy & histology / Q000502:physiology*; D008953:Models, Anatomic; D009330:Nebulizers and Vaporizers; D063087:Noninvasive Ventilation / Q000295:instrumentation*; D010316:Particle Size; D012122:Ventilators, Mechanical; D014732:Vibration
D000336:Aerosols; D000900:Anti-Bacterial Agents; D000583:Amikacin
NIV; aerosol delivery; amikacin; bilevel ventilator; breath-synchronized nebulizer; exhalation port; inhaled dose; lost dose; nebulization; nebulization mode; particle size distribution; single-limb circuit ventilator; vibrating mesh nebulizer