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https://www.readbyqxmd.com/read/28923758/methacholine-challenge-testing-a-novel-method-for-measuring-pd20
#1
Beth E Davis, Samuel K Simonson, Christianne M Blais, Donald W Cockcroft
BACKGROUND: New guidelines for methacholine challenge testing recommend reporting the test outcome as dose rather than concentration. Jet nebulizers have historically been used for methacholine challenge testing but much of the weight loss, often (incorrectly) referred to as aerosol output, is actually evaporation. The Wright® nebulizer is well characterized and still widely used, but its availability is unclear and it is non-disposable. We developed a novel method using a vibrating mesh nebulizer (Aerogen Solo®)...
September 15, 2017: Chest
https://www.readbyqxmd.com/read/28882385/lung-deposition-and-systemic-bioavailability-of-different-aerosol-devices-with-and-without-humidification-in-mechanically-ventilated-patients
#2
Islam O F Moustafa, Mohammed R A-A Ali, Moataz Al Hallag, Hoda Rabea, James B Fink, Patricia Dailey, Mohamed E A Abdelrahim
BACKGROUND: During mechanical ventilation medical aerosol delivery has been reported to be upto two fold greater with dry inhaled gas than with heated humidity. Urine levels at 0.5 h post dose (URSAL0.5%) has been confirmed as an index of lung deposition and 24 h (URSAL24%) as index of systemic absorption. Our aim was to determine the effect of humidification and aerosol device type on drug delivery to ventilated patients using urine levels. METHODS: In a randomized crossover design, 36 (18female) mechanically ventilated patients were assigned to one of three groups...
September 4, 2017: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/28874611/how-should-aerosols-be-delivered-during-invasive-mechanical-ventilation
#3
Rajiv Dhand
The delivery of aerosols to mechanically ventilated patients presents unique challenges and differs from inhaled drug delivery in spontaneously breathing patients in several respects. Successful aerosol delivery during invasive mechanical ventilation requires careful consideration of a host of factors that influence the amount of drug inhaled by the patient. Pressurized metered-dose inhalers and nebulizers (jet, ultrasonic, and vibrating mesh) are the most commonly used aerosol delivery devices in these patients, although other delivery devices, such as dry powder inhalers, soft mist inhalers, and intratracheal nebulizing catheters, could also be adapted for in-line use...
September 5, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28859915/viral-bronchiolitis-in-young-infants-new-perspectives-for-management-and-treatment
#4
REVIEW
Mauricio T Caballero, Fernando P Polack, Renato T Stein
OBJECTIVE: The aim of this review was to address advances in management and treatment of acute viral bronchiolitis in infants. SOURCES: A systematic review search was made including all articles published in English between 2010 and 2017, and available in the electronic databases PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) and specialized register of the Acute Respiratory Infections Group (Cochrane review group). The following MESH terms in English were included, using different Boolean operators for the search strategy: "bronchiolitis, viral," "diagnosis," "epidemiology," "etiology," "therapy," "virology," "prevention and control," "respiratory syncytial virus, human...
August 30, 2017: Jornal de Pediatria
https://www.readbyqxmd.com/read/28829202/effect-of-heat-moisture-exchanger-on-aerosol-drug-delivery-and-airway-resistance-in-simulated-ventilator-dependent-adults-using-jet-and-mesh-nebulizers
#5
Arzu Ari, Truong Dang, Fahad H Al Enazi, Mohammed M Alqahtani, Abdulrahman Alkhathami, Rowaida Qoutah, Ahmad S Almamary, James B Fink
BACKGROUND: Placement of a heat moisture exchanger (HME) between aerosol generator and patient has been associated with greatly reduced drug delivery. The purpose of this study was to evaluate the effect of filtered and nonfiltered HMEs placed between nebulizer and patient on aerosol deposition and airway resistance (Raw) in simulated ventilator-dependent adults. METHODS: An in vitro lung model was developed to simulate a mechanically ventilated adult (Vt 500 mL, RR 15/min, and PEEP 5 cmH2O, using two inspiratory flow rates 40 and 50 L/min) using an intubated adult manikin with an endotracheal tube (8 mmID)...
August 22, 2017: Journal of Aerosol Medicine and Pulmonary Drug Delivery
https://www.readbyqxmd.com/read/28813621/improvement-of-an-in-vitro-model-to-assess-delivered-dose-and-particle-size-for-a-vibrating-mesh-nebulizer-during-mechanical-ventilation
#6
Nani Kadrichu, Derek Daniher
BACKGROUND: In an in vitro model of mechanical ventilation with gravity-dependent filter position we observed artificially high delivered doses resulting from liquid droplet collection and precipitation of aerosolized drug. We sequentially modified the model to obtain accurate reproducible measurements of delivered dose and particle size at endotracheal tube exit. METHODS: Stepwise changes in the model included (1) altering the endotracheal tube position to a gravity-independent position, (2) adding fluid traps, (3) humidifying air near the test lung, and (4) simplifying test lung and filters...
August 16, 2017: Journal of Aerosol Medicine and Pulmonary Drug Delivery
https://www.readbyqxmd.com/read/28813613/methacholine-challenge-comparison-of-airway-responsiveness-produced-by-a-vibrating-mesh-nebulizer-versus-a-jet-nebulizer
#7
Christianne M Blais, Donald W Cockcroft, Justine Veilleux, Marie-Ève Boulay, Louis-Philippe Boulet, Gail M Gauvreau, Tara X Scime, Richard M Watson, Paul M O'Byrne, Beth E Davis
BACKGROUND: The latest methacholine challenge testing (MCT) guidelines published by the European Respiratory Society recommend the characterization of nebulizers before their use in clinics and research. Such investigations are necessary for accurately determining the provocative dose of methacholine causing a 20% fall in FEV1 (PD20) delivered by a given device. The standard English Wright (Wright) jet nebulizer recommended in the 1999 guidelines by the American Thoracic Society has become difficult to obtain and possesses some characteristics that complicate the calculation of dose delivery from this device (e...
August 16, 2017: Journal of Aerosol Medicine and Pulmonary Drug Delivery
https://www.readbyqxmd.com/read/28782710/use-of-nebulized-milrinone-in-cardiac-surgery-comparison-of-vibrating-mesh-and-simple-jet-nebulizers
#8
Paul Gavra, Maxime Laflamme, André Y Denault, Yves Théôret, Louis P Perrault, France Varin
Cardiopulmonary bypass triggers an ischemia-reperfusion injury with endothelial dysfunction in the pulmonary circulation which can result in pulmonary hypertension. Inhaled milrinone reduces this reperfusion phenomenon and two methods commonly available for administering it are simple jet and vibrating mesh nebulization. However, neither their generated milrinone particle size profiles, nor their ability to aid endothelial relaxation have been compared. Simple jet and vibrating mesh particle size distributions of milrinone were verified through cascade impaction and their efficacy was tested on a cardiopulmonary bypass (CPB) swine model...
August 4, 2017: Pulmonary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28741229/inhaled-antimicrobials-for-ventilator-associated-pneumonia-practical-aspects
#9
Garyphallia Poulakou, Dimitrios K Matthaiou, David P Nicolau, Georgios Siakallis, George Dimopoulos
Positive experience with inhaled antibiotics in pulmonary infections of patients with cystic fibrosis has paved the way for their utilization in mechanically ventilated, critically ill patients with lower respiratory tract infections. A successful antibiotic delivery depends upon the size of the generated particle and the elimination of drug impaction in the large airways and the ventilator circuit. Generated droplet size is mainly affected by the type of the nebulizer employed. Currently, jet, ultrasonic, and vibrating mesh nebulizers are marketed; the latter can deliver optimal antibiotic particle size...
July 24, 2017: Drugs
https://www.readbyqxmd.com/read/28720675/the-effect-of-nebulizer-position-on-aerosolized-epoprostenol-delivery-in-an-adult-lung-model
#10
Allison C Anderson, Meagan N Dubosky, Kelly A Fiorino, Vanessa Quintana, Carl A Kaplan, David L Vines
BACKGROUND: Aerosolized epoprostenol is an alternative for inhaled nitric oxide in the management of pulmonary arterial hypertension and possibly acute hypoxemia. Our objective was to determine differences in drug deposition based on different nebulizer positions in the ventilator circuit, using a vibrating mesh nebulizer. METHODS: An 8.0-mm inner diameter endotracheal tube (ETT) was connected to a training test lung, compliance of 30 mL/cm H2O, with a collecting filter placed at the ETT-test lung junction...
July 18, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28683216/pulmonary-drug-delivery-following-continuous-vibrating-mesh-nebulization-and-inspiratory-synchronized-vibrating-mesh-nebulization-during-noninvasive-ventilation-in-healthy-volunteers
#11
Jean-Bernard Michotte, Enrico Staderini, Anne-Sophie Aubriot, Emilie Jossen, Jonathan Dugernier, Giuseppe Liistro, Gregory Reychler
BACKGROUND: A breath-synchronized nebulization option that could potentially improve drug delivery during noninvasive positive pressure ventilation (NIPPV) is currently not available on single-limb circuit bilevel ventilators. The aim of this study was to compare urinary excretion of amikacin following aerosol delivery 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...
July 6, 2017: Journal of Aerosol Medicine and Pulmonary Drug Delivery
https://www.readbyqxmd.com/read/28647745/early-halt-of-a-randomized-controlled-study-with-3-hypertonic-saline-in-acute-bronchiolitis
#12
Ania Carsin, Emilie Sauvaget, Violaine Bresson, Karine Retornaz, Maria Cabrera, Elisabeth Jouve, Romain Truillet, Emmanuelle Bosdure, Jean-Christophe Dubus
BACKGROUND: Albeit not recommended because of contradictory results, nebulized 3% hypertonic saline is widely used for treating acute viral bronchiolitis. Whether clinical differences may be attributed to the type of nebulizer used has never been studied. OBJECTIVES: By modifying the amount of salt deposited into the airways, the nebulizer characteristics might influence clinical response. METHODS: A prospective, randomized, controlled trial included infants hospitalized in a French university hospital for a first episode of bronchiolitis...
June 24, 2017: Respiration; International Review of Thoracic Diseases
https://www.readbyqxmd.com/read/28646325/anti-tuberculosis-bacteriophage-d29-delivery-with-a-vibrating-mesh-nebulizer-jet-nebulizer-and-soft-mist-inhaler
#13
Nicholas B Carrigy, Rachel Y Chang, Sharon S Y Leung, Melissa Harrison, Zaritza Petrova, Welkin H Pope, Graham F Hatfull, Warwick J Britton, Hak-Kim Chan, Dominic Sauvageau, Warren H Finlay, Reinhard Vehring
PURPOSE: To compare titer reduction and delivery rate of active anti-tuberculosis bacteriophage (phage) D29 with three inhalation devices. METHODS: Phage D29 lysate was amplified to a titer of 11.8 ± 0.3 log10(pfu/mL) and diluted 1:100 in isotonic saline. Filters captured the aerosolized saline D29 preparation emitted from three types of inhalation devices: 1) vibrating mesh nebulizer; 2) jet nebulizer; 3) soft mist inhaler. Full-plate plaque assays, performed in triplicate at multiple dilution levels with the surrogate host Mycobacterium smegmatis, were used to quantify phage titer...
June 23, 2017: Pharmaceutical Research
https://www.readbyqxmd.com/read/28627376/inhaled-salbutamol-dose-delivered-by-jet-nebulizer-vibrating-mesh-nebulizer-and-metered-dose-inhaler-with-spacer-during-invasive-mechanical-ventilation
#14
Muhammad H E ElHansy, Marina E Boules, Assem Fouad Mohamed El Essawy, Mohamed Bakry Al-Kholy, Maha M Abdelrahman, Amira S A Said, Raghda R S Hussein, Mohamed E Abdelrahim
BACKGROUND: Patient receiving invasive mechanical ventilation (IMV) may benefit from medical aerosol, but guidance on dosing with different aerosol devices is limited to in-vitro studies. The study was designed to compare aerosol delivery with five different types of aerosol generators during IMV. METHOD: In randomized design, 60 (30 female) mechanically ventilated chronic obstructive pulmonary disease (COPD) patients were assigned to one of 5 groups. Groups 1-4 received 5000 μg salbutamol using Aerogen Pro (PRO), Aerogen Solo (SOLO), NIVO vibrating mesh and jet nebulizers (JN), respectively, while group 5 received 800 μg (8 puffs) of salbutamol via metered dose inhaler with AeroChamber-MV (MDI-AC)...
August 2017: Pulmonary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28588117/aerosol-delivery-through-adult-high-flow-nasal-cannula-with-heliox-and-oxygen
#15
Patricia A Dailey, Robert Harwood, Kyle Walsh, James B Fink, Tina Thayer, Greg Gagnon, Arzu Ari
BACKGROUND: Heliox (helium-oxygen mixture) has been shown to reduce turbulence and improve aerosol delivery in a range of clinical settings. We questioned whether heliox as compared with oxygen via high-flow nasal cannula (HFNC) would affect aerosol delivery. We hypothesized that heliox would have a significant effect on aerosol delivery as compared with oxygen with both quiet and distressed breathing patterns. METHODS: A vibrating mesh nebulizer was placed at the inlet of a humidifier via HFNC with small adult cannula distal to the heated-wire circuit with prongs placed into simulated nares with a T-shaped trap and absolute filter connected to a breath simulator set to adult quiet and distressed breathing parameters...
June 6, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28470113/nebulized-drug-delivery-in-respiratory-medicine-what-does-the-future-hold
#16
John N Pritchard
In the later half of the 20th century, nebulized therapy was in decline, but in the 21st century the prospects for the expanded use of nebulized therapy within respiratory medicine look bright. The advent of mesh nebulizers, which combine the universal applicability of the nebulizer in the treatment of all respiratory patients with the convenience of portable inhaler use, is ideally timed to capitalize on the forecast of increased numbers of patients who will require nebulized therapy in the future. This special report will highlight some of the opportunities that the development of mesh nebulizers presents in the field of respiratory medicine...
June 2017: Therapeutic Delivery
https://www.readbyqxmd.com/read/28469943/deposition-dosages-of-three-cromolyn-forms-by-cascade-impactor
#17
Norihide Murayama, Kei Asai, Kikuno Murayama, Chihiro Kitatsuji, Satoru Doi
Among inhaled asthma therapies, the present study aimed to identify factors for selecting the type of inhalation therapy for asthma. Three methods are used to deliver inhaled cromoglycate, and the airway deposition rate was evaluated using a cascade impactor with 3 dosage forms: dry powder (DP), pressurized metered dose inhaler (pMDI), and solution (jet- and mesh-types). The percentage of particles with diameters of 2-6 μm was 17.0% for the capsule, 51.8% for pMDI, 49.0% for jet-type NE-C28, and 40.4% for mesh-type NE-U22...
2017: Journal of Drug Delivery
https://www.readbyqxmd.com/read/28463044/aerosol-delivery-with-two-nebulizers-through-high-flow-nasal-cannula-a-randomized-cross-over-single-photon-emission-computed-tomography-computed-tomography-study
#18
Jonathan Dugernier, Michel Hesse, Thibaud Jumetz, Emilie Bialais, Jean Roeseler, Virginie Depoortere, Jean-Bernard Michotte, Xavier Wittebole, Stephan Ehrmann, Pierre-François Laterre, François Jamar, Gregory Reychler
BACKGROUND: High-flow nasal cannula use is developing in ICUs. The aim of this study was to compare aerosol efficiency by using two nebulizers through a high-flow nasal cannula: the most commonly used jet nebulizer (JN) and a more efficient vibrating-mesh nebulizer (VN). METHODS: Aerosol delivery of diethylenetriaminepentaacetic acid labeled with technetium-99m (4 mCi/4 mL) to the lungs by using a VN (Aerogen Solo(®); Aerogen Ltd., Galway, Ireland) and a constant-output JN (Opti-Mist Plus Nebulizer(®); ConvaTec, Bridgewater, NJ) through a high-flow nasal cannula (Optiflow(®); Fisher & Paykel, New Zealand) was compared in six healthy subjects...
May 2, 2017: Journal of Aerosol Medicine and Pulmonary Drug Delivery
https://www.readbyqxmd.com/read/28441181/inhaled-treprostinil-drug-delivery-during-mechanical-ventilation-and-spontaneous-breathing-using-two-different-nebulizers
#19
Donna K Parker, Shuijie Shen, Jiang Zheng, D Dunbar Ivy, Dave N Crotwell, Justin C Hotz, Robert M DiBlasi
OBJECTIVES: To determine the feasibility of delivering inhaled treprostinil during mechanical ventilation and spontaneous unassisted ventilation using the Tyvaso Inhalation System and the vibrating mesh nebulizer. We sought to compare differences in fine particle fraction, and absolute inhaled treprostinil mass delivered to neonatal, pediatric, and adult models affixed with a face mask, conventional, and high-frequency ventilation between Tyvaso Inhalation System and with different nebulizer locations between Tyvaso Inhalation System and vibrating mesh nebulizer...
June 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28435031/clinical-outcome-associated-with-the-use-of-different-inhalation-method-with-and-without-humidification-in-asthmatic-mechanically-ventilated-patients
#20
Islam O F Moustafa, Muhammad H E ElHansy, Moataz Al Hallag, James B Fink, Patricia Dailey, Hoda Rabea, Mohamed E A Abdelrahim
BACKGROUND: Inhaled-medication delivered during mechanical-ventilation is affected by type of aerosol-generator and humidity-condition. Despite many in-vitro studies related to aerosol-delivery to mechanically-ventilated patients, little has been reported on clinical effects of these variables. The aim of this study was to determine effect of humidification and type of aerosol-generator on clinical status of mechanically ventilated asthmatics. METHOD: 72 (36 females) asthmatic subjects receiving invasive mechanical ventilation were enrolled and assigned randomly to 6 treatment groups of 12 (6 females) subjects each received, as possible, all inhaled medication using their assigned aerosol generator and humidity condition during delivery...
August 2017: Pulmonary Pharmacology & Therapeutics
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