title: Aerosol delivery with two ventilation modes during mechanical ventilation: a randomized study.
abstract: BACKGROUND
  Volume-controlled ventilation has been suggested to optimize lung deposition during nebulization although promoting spontaneous ventilation is targeted to avoid ventilator-induced diaphragmatic dysfunction. Comparing topographic aerosol lung deposition during volume-controlled ventilation and spontaneous ventilation in pressure support has never been performed. The aim of this study was to compare lung deposition of a radiolabeled aerosol generated with a vibrating-mesh nebulizer during invasive mechanical ventilation, with two modes: pressure support ventilation and volume-controlled ventilation.
  
  
  METHODS
  Seventeen postoperative neurosurgery patients without pulmonary disease were randomly ventilated in pressure support or volume-controlled ventilation. Diethylenetriaminepentaacetic acid labeled with technetium-99m (2 mCi/3 mL) was administrated using a vibrating-mesh nebulizer (Aerogen Solo(®), provided by Aerogen Ltd, Galway, Ireland) connected to the endotracheal tube. Pulmonary and extrapulmonary particles deposition was analyzed using planar scintigraphy.
  
  
  RESULTS
  Lung deposition was 10.5 ± 3.0 and 15.1 ± 5.0 % of the nominal dose during pressure support and volume-controlled ventilation, respectively (p < 0.05). Higher endotracheal tube and tracheal deposition was observed during pressure support ventilation (27.4 ± 6.6 vs. 20.7 ± 6.0 %, p < 0.05). A similar penetration index was observed for the right (p = 0.210) and the left lung (p = 0.211) with both ventilation modes. A high intersubject variability of lung deposition was observed with both modes regarding lung doses, aerosol penetration and distribution between the right and the left lung.
  
  
  CONCLUSIONS
  In the specific conditions of the study, volume-controlled ventilation was associated with higher lung deposition of nebulized particles as compared to pressure support ventilation. The clinical benefit of this effect warrants further studies. Clinical trial registration NCT01879488.
authors.affiliation: Soins Intensifs, Médecine Physique, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium. Jonathan.dugernier@uclouvain.be.|Institut de Recherche Expérimentale et Clinique (IREC), Pneumologie, ORL & Dermatologie, Université catholique de Louvain, 1200, Brussels, Belgium. Jonathan.dugernier@uclouvain.be.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dugernier
authors.affiliation: Médecine Physique, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.|Institut de Recherche Expérimentale et Clinique (IREC), Pneumologie, ORL & Dermatologie, Université catholique de Louvain, 1200, Brussels, Belgium.
authors.forename: Gregory
authors.initials: G
authors.lastname: Reychler
authors.affiliation: Soins Intensifs, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: Xavier
authors.initials: X
authors.lastname: Wittebole
authors.affiliation: Soins Intensifs, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: Jean
authors.initials: J
authors.lastname: Roeseler
authors.affiliation: Médecine Nucléaire, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: Virginie
authors.initials: V
authors.lastname: Depoortere
authors.affiliation: Soins Intensifs, Clinique Notre-Dame de Grâce, Chaussée de Nivelles 212, Gosselies, Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Sottiaux
authors.affiliation: Haute Ecole de Santé Vaud, Filière physiothérapie, University of Applied Sciences and Arts Western Switzerland, Avenue de Beaumont 21, 1011, Lausanne, Switzerland.
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Michotte
authors.affiliation: Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: Rita
authors.initials: R
authors.lastname: Vanbever
authors.affiliation: Soins Intensifs, Clinique Saint-Pierre, Avenue Reine Fabiola 9, 1340, Ottignies, Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Dugernier
authors.affiliation: Radiologie Interventionnelle, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Goffette
authors.affiliation: Anesthésiologie, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: Marie-Agnes
authors.initials: MA
authors.lastname: Docquier
authors.affiliation: Neurochirurgie, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: Christian
authors.initials: C
authors.lastname: Raftopoulos
authors.affiliation: Soins Intensifs, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Hantson
authors.affiliation: Médecine Nucléaire, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: François
authors.initials: F
authors.lastname: Jamar
authors.affiliation: Soins Intensifs, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Laterre
keywords: Aerosol delivery; Invasive mechanical ventilation; Ventilation mode; Vibrating-mesh nebulizer