Abstract
Background: Spontaneously breathing pediatric patients who are intubated often receive inhaled medications while disconnected from the ventilator circuit. Several medication delivery devices are available. Increased knowledge of drug delivery under this circumstance would allow for optimization of inhaled therapies in that population.
Methods: A breathing simulator (VT 200 ml, iT 0.8s, and RR 20/min) was connected to a collection filter, followed by a 5 mm ID cuffed endotracheal tube. Albuterol was delivered via jet nebulizer/t-piece/50 ml tubing extension (6 L/min, 2500 µg/3ml) for 15 minutes. The pMDI (90 µg/puff)/valved holding chamber, and the soft mist inhaler (Combivent Respimat, 100 µg/puff)/adapter, were actuated at the beginning of the inhalation 4 times per test with 4 breaths following each actuation. The pMDI and nebulizer were also tested using the assisted technique (breath support with resuscitation bag). The nebulizer was configured with the unit connected to the endotracheal tube (proximal) or with the extension tubing interposed between them (distal). Tests were done in quadruplicate, and albuterol measured by spectrophotometry (276 nm).
Results: (filter dose X±SD in µg)
Conclusion: Using standard pediatric dosage, the nebulizer delivered 5 to 7-fold more albuterol than the pMDI or the soft mist inhaler. Placing the nebulizer distal to the endotracheal tube reduced delivery by 56% but was still superior to other devices. The use of the assisted technique did not improve drug delivery.
Footnotes
Cite this article as: European Respiratory Journal 2019; 54: Suppl. 63, PA1019.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2019