Published ahead of print on July 31, 2003, doi:10.1164/rccm.200210-1167OC Am. J. Respir. Crit. Care Med., Volume 168, Number 10, November 2003, 1205-1209 A more recent version of this article appeared on November 15, 2003
Submitted on October 17, 2002 AEROSOL DELIVERY AND MODERN MECHANICAL VENTILATION: IN VITRO / IN VIVO EVALUATIONDorisanne D Miller1,1 Respiratory Care, State University of New York, University Hospital, Stony Brook, Stony Brook, NY, USA, 2 Medicine, Division of Pulmonary and Critical Care Medicine, State University of New York, School of Medicine, Stony Brook, Stony Brook, NY, USA * To whom correspondence should be addressed. E-mail: gerald.smaldone{at}stonybrook.edu.
Aerosol delivery via mechanical ventilator remains unregulated with no standards for drug delivery to intubated patients. Bench models predicting drug delivery have not been validated in vivo. For modern ventilator designs we chose to identify, on the bench, the most important variables affecting aerosol delivery and to correlate in vitro predictions of aerosol delivery with in vivo endpoints independent of patient response. Test aerosols of albuterol and antibiotics were compared. Bench measurements of inhaled mass (%nebulizer charge, mean±SEM) ranged from 5.7±0.5% to 37.4±1.6% with breath actuated nebulization and humidity identified as the most important factors determining aerosol delivery. In patients, sputum levels of deposited antibiotics varied from 1.10 to 19.6 mg/mL/mg. Variation in sputum levels correlated with predictions from the in vitro model. Aerosol delivery in ventilated patients can be efficient and reproducible only if defined ventilator parameters are tightly controlled. Key parameters can be determined via in vitro bench testing defining delivery standards for clinical trials of drugs with narrow therapeutic/toxicity ratios. Key words: Aerosolized antibiotics, nebulizers, bronchodilators, humidification, sputum
This article has been cited by other articles:
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
