Pulmonary drug delivery following continuous vibrating mesh nebulization and inspiratory synchronized vibrating mesh nebulization during noninvasive ventilation in healthy volunteers

Michotte, Jean-Bernard (HESAV, HES-SO // University of Applied Sciences Western Switzerland) ; Staderini, Enrico (School of Management and Engineering Vaud, HES-SO // University of Applied Sciences Western Switzerland) ; Aubriot, Anne-Sophie (Cliniques Universitaires Saint-Luc, Centre de Référence pour la Mucoviscidose, 1200 Brussels, Belgium) ; Jossen, Emilie (Ligue pulmonaire neuchâteloise, 2034 Peseux, Switzerland) ; Dugernier, Jonathan (Cliniques Universitaires Saint-Luc, Service des soins intensifs, 1200 Brussels, Belgium) ; Liistro, Giuseppe (Cliniques Universitaires Saint-Luc, Service de Pneumologie; Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, 1200 Brussels, Belgium) ; Reychler, Gregory (Cliniques Universitaires Saint-Luc, Service de Pneumologie; Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, 1200 Brussels, Belgium)

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. Materials and Methods: A crossover clinical trial involving 6 noninvasive ventilated healthy volunteers (mean age of 32.3– 9.5 y) randomly assigned to both vibrating mesh nebulization modes was conducted: Inspi-Neb delivered aerosol during only the whole inspiratory phase, whereas Conti-Neb delivered aerosol continuously. All subjects inhaled amikacin solution (500 mg/4 mL) during NIPPV using a single-limb bilevel ventilator (inspiratory positive airway pressure: 12 cm H2O, and expiratory positive airway pressure: 5 cm H2O). Pulmonary drug delivery of amikacin following both nebulization modes was compared by urinary excretion of drug for 24 hours post-inhalation. Results: The total daily amount of amikacin excreted in the urine was significantly higher with Inspi-Neb (median: 44.72 mg; interquartile range [IQR]: 40.50–65.13) than with Conti-Neb (median: 40.07 mg; IQR: 31.00–43.73), ( p ¼ 0.02). The elimination rate constant of amikacin (indirect measure of the depth of drug penetration into the lungs) was significantly higher with Inspi-Neb (median: 0.137; IQR: 0.113–0.146) than with Conti-Neb (median: 0.116; IQR: 0.105–0.130), ( p ¼ 0.02). However, the mean pulmonary drug delivery rate, expressed as the ratio between total daily urinary amount of amikacin and nebulization time, was significantly higher with Conti-Neb (2.03 mg/min) than with Inspi-Neb (1.09 mg/min) ( p < 0.01). Conclusions: During NIPPV with a single-limb circuit bilevel ventilator, the use of inspiratory synchronized vibrating mesh nebulization may improve pulmonary drug delivery compared with conventional continuous vibrating mesh nebulization.


Mots-clés:
Type d'article:
scientifique
Faculté:
Ingénierie et Architecture
Santé
Ecole:
HEIG-VD Haute Ecole d’Ingénierie et de Gestion du Canton de Vaud
HESAV Haute Ecole de Santé Vaud
Institut:
iAi-Institut d'Automatisation Industrielle
Classification:
Ingénierie
Date:
2018
Pagination:
9 p.
Publié dans
Journal of Aerosol Medicine and Pulmonary Drug Delivery
Numérotation (vol. no.):
2018, 31, 1, pp. 33-41
DOI:
ISSN:
1941-2711
Date d'embargo:
2019-02-28
Le document apparaît dans:

Note: The file is under embargo until: 2019-02-28


 Notice créée le 2018-05-29, modifiée le 2018-08-19

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