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James B Fink - One of the best experts on this subject based on the ideXlab platform.

  • Quantifying Delivered Dose with Jet and Mesh Nebulizers during Spontaneous Breathing, Noninvasive Ventilation, and Mechanical Ventilation in a Simulated Pediatric Lung Model with Exhaled Humidity
    'MDPI AG', 2021
    Co-Authors: Arzu Ari, James B Fink
    Abstract:

    Acutely ill children may transition between spontaneous breathing (SB), noninvasive ventilation (NIV), and mechanical ventilation (MV), and commonly receive the same drug dosage with each type of ventilatory support and interface. This study aims to determine the aerosol deposition with jet (JN) and mesh nebulizers (MN) during SB, NIV, and MV using a pediatric lung model. Drug delivery with JN (Mistymax10) and MN (Aerogen Solo) was compared during SB, NIV, and MV using three different lung models set to simulate the same breathing parameters (Vt 250 mL, RR 20 bpm, I:E ratio 1:3). A Heated Humidifier was placed between the filter and test lung to simulate exhaled humidity (35 ± 2 °C, 100% RH) with all lung models. Albuterol sulfate (2.5 mg/3 mL) was delivered, and the drug deposited on an absolute filter was eluted and analyzed with spectrophotometry. Aerosol delivery with JN was not significantly different during MV, NIV, and SB (p = 0.075), while inhaled dose obtained with MN during MV was greater than NIV and SB (p = 0.001). The delivery efficiency of MN was up to 3-fold more than JN during MV (p = 0.008), NIV (p = 0.005), and SB (p = 0.009). Delivered dose with JN was similar during MV, NIV, and SB, although the delivery efficiency of MN differs with different modes of ventilation

  • Delivered dose with jet and mesh nebulisers during spontaneous breathing, noninvasive ventilation and mechanical ventilation using adult lung models
    'European Respiratory Society (ERS)', 2021
    Co-Authors: Arzu Ari, James B Fink
    Abstract:

    What is the delivered dose with jet and mesh nebulisers during spontaneous breathing (SB), noninvasive ventilation (NIV), and mechanical ventilation (MV) using an adult lung model with exhaled humidity (EH)? The delivery of salbutamol sulfate (2.5 mg per 3 mL) with jet (Mistymax10) and mesh nebulisers (Aerogen Solo) was compared during SB, NIV, and MV using breathing parameters (tidal volume 450 mL, respiratory rate 20 breaths per min, inspiratory:expiratory ratio 1:3) with three lung models simulating exhaled humidity. A manikin was attached to a sinusoidal pump via a filter at the bronchi to simulate an adult with SB. A ventilator (V60) was attached via a facemask to a manikin with a filter at the bronchi connected to a test lung to simulate an adult receiving NIV. A ventilator-dependent adult was simulated through a ventilator (Servo-i) operated with a Heated Humidifier (Fisher & Paykel) attached to an endotracheal tube (ETT) with a Heated-wire circuit. The ETT was inserted into a filter (Respirgard II). A Heated Humidifier was placed between the filter and test lung to simulate exhaled humidity (35±2°C, 100% relative humidity). Nebulisers were placed at the Y-piece of the inspiratory limb during MV and positioned between the facemask and the leak-port during NIV. A mouthpiece was used during SB. The delivered dose was collected in an absolute filter that was attached to the bronchi of the mannequin during each aerosol treatment and measured with spectrophotometry. Drug delivery during MV was significantly greater than during NIV and SB with a mesh nebuliser (p=0.0001) but not with a jet nebuliser (p=0.384). Delivery efficiency of the mesh nebuliser was greater than the jet nebuliser during MV (p=0.0001), NIV (p=0.0001), and SB (p=0.0001). Aerosol deposition obtained with a mesh nebuliser was greater and differed between MV, NIV, and SB, while deposition was low with a jet nebuliser and similar between the modes of ventilation tested

  • effect of heat moisture exchanger on aerosol drug delivery and airway resistance in simulated ventilator dependent adults using jet and mesh nebulizers
    Journal of Aerosol Medicine and Pulmonary Drug Delivery, 2017
    Co-Authors: Arzu Ari, Truong Dang, Fahad Al H Enazi, Mohammed M Alqahtani, Abdulrahman Alkhathami, Rowaida Qoutah, Ahmad S Almamary, James B Fink
    Abstract:

    Abstract 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). The bronchi of the manikin were connected to a Y-adapter through a collecting filter (Respirgard II) attached to a test lung through a Heated Humidifier (37°C producing 100% relative humidity) to simulate exhaled humidity. For treatment conditions, a nonfiltered HME (ThermoFlo™ 6070; ARC Medical) and filtered HMEs (ThermoFlo™ Filter; ARC Medical and PALL Ultipor; Pall Medical) were placed bet...

  • in vitro comparison of heliox and oxygen in aerosol delivery using pediatric high flow nasal cannula
    Pediatric Pulmonology, 2011
    Co-Authors: Arzu Ari, Robert Harwood, Meryl M Sheard, Patricia Dailey, James B Fink
    Abstract:

    Drug administration via high flow nasal cannula (HFNC) has been described in pediatrics but the amount of albuterol delivery with an HFNC is not known. The purpose of this study is to quantify aerosol delivery with heliox and oxygen (O(2)) in a model of pediatric ventilation. A vibrating mesh nebulizer (Aeroneb Solo, Aerogen) was placed on the inspiratory inlet of a Heated Humidifier and Heated wire circuit attached to a pediatric nasal cannula (Optiflow, Fisher & Paykel). Breathing parameters were tidal volume (V(t)) 100 ml, respiratory rate (RR) 20/min, and I-time of 1 sec. Albuterol sulfate (2.5 mg/3 ml) was administered through a pediatric HFNC with O(2) (100%) and heliox (80/20% mixture). A total of 12 runs, using O(2) and heliox were conducted at 3 and 6 L/min (n = 3). Drug was collected on an absolute filter, eluted and measured using spectrophotometry. The percent inhaled dose (mean ± SD) was similar with heliox and O(2) at 3 L/min (11.41 ± 1.54 and 10.65 ± 0.51, respectively; P = 0.465). However at 6 L/min drug deposition was ≥ 2-fold greater with heliox (5.42 ± 0.54) than O(2) (1.95 ± 0.50; P = 0.01). Using a pediatric model of HFNC, reducing delivered flow from 6 to 3 L/min increased inhaled albuterol delivery ≥ 2-fold but eliminated the increase in inhaled drug efficiency associated with heliox.

  • in vitro comparison of heliox and oxygen in aerosol delivery using pediatric high flow nasal cannula
    Pediatric Pulmonology, 2011
    Co-Authors: Robert Harwood, Meryl M Sheard, Patricia Dailey, James B Fink
    Abstract:

    Summary. Drug administration via high flow nasal cannula (HFNC) has been described in pediatrics but the amount of albuterol delivery with an HFNC is not known. The purpose of this study is to quantify aerosol delivery with heliox and oxygen (O2) in a model of pediatric ventilation. A vibrating mesh nebulizer (Aeroneb Solo, Aerogen) was placed on the inspiratory inlet of a Heated Humidifier and Heated wire circuit attached to a pediatric nasal cannula (Optiflow, Fisher & Paykel). Breathing parameters were tidal volume (Vt) 100 ml, respiratory rate (RR) 20/min, and I-time of 1 sec. Albuterol sulfate (2.5 mg/3 ml) was administered through a pediatric HFNC with O2 (100%) and heliox (80/20% mixture). A total of 12 runs, using O2 and heliox were conducted at 3 and 6 L/ min (n ¼ 3). Drug was collected on an absolute filter, eluted and measured using spectropho

Samir Jaber - One of the best experts on this subject based on the ideXlab platform.

  • impact of the anesthetic conserving device on respiratory parameters and work of breathing in critically ill patients under light sedation with sevoflurane
    Anesthesiology, 2014
    Co-Authors: Russell Chabanne, Samir Jaber, Sebastien Perbet, Emmanuel Futier, Nordine Ait Ben Said, Jeanetienne Bazin, Bruno Pereira, Jeanmichel Constantin
    Abstract:

    BACKGROUND Sevoflurane sedation in the intensive care unit is possible with a special heat and moisture exchanger called the Anesthetic Conserving Device (ACD) (AnaConDa; Sedana Medical AB, Uppsala, Sweden). The ACD, however, may corrupt ventilatory mechanics when used during the weaning process of intensive care unit patients. The authors compared the ventilatory effects of light-sedation with sevoflurane administered with the ACD and those of classic management, consisting of a Heated Humidifier and intravenous sedation, in intensive care unit patients receiving pressure-support ventilation. METHODS Fifteen intensive care unit patients without chronic pulmonary disease were included. A target Richmond Agitation Sedation Scale level of -1/-2 was obtained with intravenous remifentanil (baseline 1-condition). Two successive interventions were tested: replacement of the Heated Humidifier by the ACD without sedation change (ACD-condition) and sevoflurane with the ACD with an identical target level (ACD-sevoflurane-condition). Patients finally returned to baseline (baseline 2-condition). Work of breathing, ventilatory patterns, blood gases, and tolerance were recorded. A steady state of 30 min was achieved for each experimental condition. RESULTS ACD alone worsened ventilatory parameters, with significant increases in work of breathing (from 1.7 ± 1.1 to 2.3 ± 1.2 J/l), minute ventilation, P0,1, intrinsic positive end-expiratory pressure (from 1.3 ± 2.6 to 4.7 ± 4.2 cm H2O), inspiratory pressure swings, and decreased patient comfort. Sevoflurane normalized work of breathing (from 2.3 ± 1.2 to 1.8 ± 1 J/l), intrinsic positive end-expiratory pressure (from 4.7 ± 4.2 to 1.8 ± 2 cm H2O), inspiratory pressure swings, other ventilatory parameters, and patient tolerance. CONCLUSIONS ACD increases work of breathing and worsens ventilatory parameters. Sevoflurane use via the ACD (for a light-sedation target) normalizes respiratory parameters. In this patient's population, light-sedation with sevoflurane and the ACD may be possible during the weaning process.

  • 6 cmh2o continuous positive airway pressure versus conventional oxygen therapy in severe viral bronchiolitis a randomized trial
    Pediatric Pulmonology, 2013
    Co-Authors: Christophe Milesi, Samir Jaber, Clementine Combes, Stefan Matecki, Thibaut Mura, Aurelien Jacquot, Odile Pidoux, Nathalie Chautemps, Aline Rideau Batista Novais, Jeancharles Picaud
    Abstract:

    Objective: To compare the effects of nasal continuous positive airway pressure (nCPAP) and conventional oxygen therapy on the clinical signs of respiratory distress and the respiratory muscle workload in acute viral bronchiolitis. Design: Prospective, randomized, monocentric study carried out in the pediatric intensive care unit (PICU) of a university hospital. Patients: Infants <6 months old, admitted to the PICU with severe respiratory syncytial virus bronchiolitis. Intervention: The patients were randomized into two groups for 6 hr. The nCPAP group (n = 10) received 6 cmH(2)O pressure support delivered by a jet flow generator and the control group (n = 9) received an air/oxygen mixture from a Heated Humidifier. Respiratory distress was assessed by the modified Wood's clinical asthma score (m-WCAS), and inspiratory muscle work was evaluated by calculating the pressure-time product per breath (PTP(insp) /breath) and per minute (PTP(insp) /min) from the esophageal pressure (Pes) recordings. Measurements and main results: Compared with control condition, nCPAP decreased m-WCAS [-2.4 (1.05) vs. -0.5 (1.3), P = 0.03], PTPes(insp)/breath [-9.7 (5.7) vs. -1.4 (8.2), P = 0.04], PTPes(insp) /min [-666 (402) vs. -116 (352), P = 0.015], and FiO(2) [-7 (10) vs. +5 (15), P = 0.05]. Significant worsening of m-WCAS was only observed in the control group (4/9 vs. 0/10, P = 0.03). Conclusions: nCPAP rapidly decreased inspiratory work in young infants with acute bronchiolitis. Improvement in the respiratory distress score at 6 hr was proportional to the initial clinical severity, suggesting the importance of rapid nCPAP initiation in the more severe forms of the disease.

  • discomfort associated with underhumidified high flow oxygen therapy in critically ill patients
    Intensive Care Medicine, 2009
    Co-Authors: Gerald Chanques, Jeanmichel Constantin, Magali Sauter, Boris Jung, Mustapha Sebbane, Daniel Verzilli, Jeanyves Lefrant, Samir Jaber
    Abstract:

    To measure (1) the discomfort in non-intubated patients under high-flow oxygen therapy (HFOT) humidified with bubble (BH) or Heated Humidifiers (HH), and (2) the hygrometric properties of oxygen with a BH and an HH. This was a randomized cross-over study in critically ill patients during a 3-day period. The humidification device used at days 1 and 3 was changed for the other at day 2. (2) It was also an experimental bench study using the psychrometric method with five randomized flows (3, 6, 9, 12 and 15 l/min) and different humidification techniques. Discomfort, particularly dryness of the mouth and throat, was measured for two humidification conditions (BH and HH) using a 0–10 numerical rating scale (NRS) by patients requiring HFOT with a face mask at a flow ≥5 l/min, in a double-blinded condition. (1) In this clinical study, 30 patients treated by HFOT at a median flow of 7.8 l/min (5.1–10.9) were included. The global incidence of moderate (NRS = 4–6) and severe discomfort (NRS = 7–10) was 25 and 29%, respectively. The median intensities of both mouth and throat dryness were significantly lower with the HH than with the BH [7.8 (5.0–9.4) vs. 5.0 (3.1–7.0), P = 0.001 and 5.8 (2.3–8.5) vs. 4.3 (2.0–5.0), P = 0.005, respectively]. (2) In the bench study, the mean absolute humidity measured at an ambient temperature of 26°C with the HH was two times greater than with the BH (30 ± 1 vs. 16 ± 2 mg/l, P < 0.05) regardless of the flow rate. Compared to bubble Humidifiers, the use of a Heated-Humidifier in patients with high-flow oxygen therapy is associated with a decrease of dryness symptoms mediated by increased humidity delivered to the patient.

  • Long-term effects of different humidification systems on endotracheal tube patency: evaluation by the acoustic reflection method.
    Anesthesiology, 2004
    Co-Authors: Samir Jaber, Jérôme Pigeot, Redouane Fodil, Salvatore Maurizio Maggiore, Alain Harf, Daniel Isabey, Laurent Brochard, Bruno Louis
    Abstract:

    Background Accumulation of mucous secretions in an endotracheal tube (ETT) increases its resistance, and the amount of deposit may be affected by the quality of humidification and heating of the inspired gas. Methods The authors assessed the impact of two humidification systems, a Heated Humidifier (HH) and a hygroscopic-hydrophobic heat and moisture exchanger (HME), on the ETT patency in patients selected to require mechanical ventilation for more than 48 h. This comparison was performed over two consecutive periods and used the acoustic reflection method, which characterizes the amount and site of ETT obstruction and allows estimating ETT inner volume and resistance. Measurements were performed three times a week over the period of mechanical ventilation. Comparisons were performed at mid duration and at the end of the mechanical ventilation period. Results The HH was used in 34 patients, and the HME was used in 26 patients. The two groups had similar severity and duration of mechanical ventilation. At mid duration of mechanical ventilation (5.5 +/- 3.3 vs. 4.8 +/- 3.3 days; P = 0.4), no difference was observed in ETT volume and resistance between the two groups. At the end of the study period (10.5 +/- 5.8 vs. 9.6 +/- 6.3 days of mechanical ventilation; P = 0.4), ETT volume was reduced to a greater extent with HME than with HH (-3.3 +/- 2.9 vs. -5.1 +/- 2.5%; P = 0.008), and ETT resistance increased significantly more with the HME than with the HH (8.4 +/- 12.2 vs. 19.4 +/- 17.7%; P = 0.001). Conclusion Prolonged use of humidification systems results in progressive reduction of ETT patency, and to a greater extent with HMEs than with HHs.

  • comparison of the effects of heat and moisture exchangers and Heated Humidifiers on ventilation and gas exchange during non invasive ventilation
    Intensive Care Medicine, 2002
    Co-Authors: Samir Jaber, Gerald Chanques, Stefan Matecki, Michele Ramonatxo, Bruno Souche, Pierrefrancois Perrigault, Jeanjacques Eledjam
    Abstract:

    Abstract Objective. To compare the short-term effects of a heat and moisture exchanger (HME) and a Heated Humidifier (HH) during non-invasive ventilation (NIV). Design. Prospective, clinical investigation. Setting. Intensive care unit of a university hospital. Patients. Twenty-four patients with acute respiratory failure (ARF). Intervention. Each patient was studied with a HME and a HH in a random order during two consecutive 20min periods of NIV. Measurements and results. Respiratory rate (RR), expiratory tidal volume (VTe) and expiratory minute ventilation (VE) were measured during the last 5 min of each period and blood gases were measured. Mean pressure support and positive end-expiratory pressure levels were, respectively, 15±4 and 6±2 cmH2O. VE was significantly greater with HME than with HH (14.8±4.8 vs 13.2±4.3 l/min; p<0.001). This increase in VE was the result of a greater RR for HME than for HH (26.5±10.6 vs 24.1±9.8 breaths/min; p=0.002), whereas the VT for HME was similar to that for HH (674±156 vs 643±148 ml; p=0.09). Arterial partial pressure of carbon dioxide (PaCO2) was significantly higher with a HME than with a HH (43.4±8.9 vs 40.8±8.2 mmHg; p<0.005), without significantly changing oxygenation. Conclusion. During NIV the increased dead space of a HME can negatively affect ventilatory function and gas exchange. The effect of HME dead space may decrease efficiency of NIV in patients with ARF.

Arzu Ari - One of the best experts on this subject based on the ideXlab platform.

  • Quantifying Delivered Dose with Jet and Mesh Nebulizers during Spontaneous Breathing, Noninvasive Ventilation, and Mechanical Ventilation in a Simulated Pediatric Lung Model with Exhaled Humidity
    'MDPI AG', 2021
    Co-Authors: Arzu Ari, James B Fink
    Abstract:

    Acutely ill children may transition between spontaneous breathing (SB), noninvasive ventilation (NIV), and mechanical ventilation (MV), and commonly receive the same drug dosage with each type of ventilatory support and interface. This study aims to determine the aerosol deposition with jet (JN) and mesh nebulizers (MN) during SB, NIV, and MV using a pediatric lung model. Drug delivery with JN (Mistymax10) and MN (Aerogen Solo) was compared during SB, NIV, and MV using three different lung models set to simulate the same breathing parameters (Vt 250 mL, RR 20 bpm, I:E ratio 1:3). A Heated Humidifier was placed between the filter and test lung to simulate exhaled humidity (35 ± 2 °C, 100% RH) with all lung models. Albuterol sulfate (2.5 mg/3 mL) was delivered, and the drug deposited on an absolute filter was eluted and analyzed with spectrophotometry. Aerosol delivery with JN was not significantly different during MV, NIV, and SB (p = 0.075), while inhaled dose obtained with MN during MV was greater than NIV and SB (p = 0.001). The delivery efficiency of MN was up to 3-fold more than JN during MV (p = 0.008), NIV (p = 0.005), and SB (p = 0.009). Delivered dose with JN was similar during MV, NIV, and SB, although the delivery efficiency of MN differs with different modes of ventilation

  • Delivered dose with jet and mesh nebulisers during spontaneous breathing, noninvasive ventilation and mechanical ventilation using adult lung models
    'European Respiratory Society (ERS)', 2021
    Co-Authors: Arzu Ari, James B Fink
    Abstract:

    What is the delivered dose with jet and mesh nebulisers during spontaneous breathing (SB), noninvasive ventilation (NIV), and mechanical ventilation (MV) using an adult lung model with exhaled humidity (EH)? The delivery of salbutamol sulfate (2.5 mg per 3 mL) with jet (Mistymax10) and mesh nebulisers (Aerogen Solo) was compared during SB, NIV, and MV using breathing parameters (tidal volume 450 mL, respiratory rate 20 breaths per min, inspiratory:expiratory ratio 1:3) with three lung models simulating exhaled humidity. A manikin was attached to a sinusoidal pump via a filter at the bronchi to simulate an adult with SB. A ventilator (V60) was attached via a facemask to a manikin with a filter at the bronchi connected to a test lung to simulate an adult receiving NIV. A ventilator-dependent adult was simulated through a ventilator (Servo-i) operated with a Heated Humidifier (Fisher & Paykel) attached to an endotracheal tube (ETT) with a Heated-wire circuit. The ETT was inserted into a filter (Respirgard II). A Heated Humidifier was placed between the filter and test lung to simulate exhaled humidity (35±2°C, 100% relative humidity). Nebulisers were placed at the Y-piece of the inspiratory limb during MV and positioned between the facemask and the leak-port during NIV. A mouthpiece was used during SB. The delivered dose was collected in an absolute filter that was attached to the bronchi of the mannequin during each aerosol treatment and measured with spectrophotometry. Drug delivery during MV was significantly greater than during NIV and SB with a mesh nebuliser (p=0.0001) but not with a jet nebuliser (p=0.384). Delivery efficiency of the mesh nebuliser was greater than the jet nebuliser during MV (p=0.0001), NIV (p=0.0001), and SB (p=0.0001). Aerosol deposition obtained with a mesh nebuliser was greater and differed between MV, NIV, and SB, while deposition was low with a jet nebuliser and similar between the modes of ventilation tested

  • effect of heat moisture exchanger on aerosol drug delivery and airway resistance in simulated ventilator dependent adults using jet and mesh nebulizers
    Journal of Aerosol Medicine and Pulmonary Drug Delivery, 2017
    Co-Authors: Arzu Ari, Truong Dang, Fahad Al H Enazi, Mohammed M Alqahtani, Abdulrahman Alkhathami, Rowaida Qoutah, Ahmad S Almamary, James B Fink
    Abstract:

    Abstract 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). The bronchi of the manikin were connected to a Y-adapter through a collecting filter (Respirgard II) attached to a test lung through a Heated Humidifier (37°C producing 100% relative humidity) to simulate exhaled humidity. For treatment conditions, a nonfiltered HME (ThermoFlo™ 6070; ARC Medical) and filtered HMEs (ThermoFlo™ Filter; ARC Medical and PALL Ultipor; Pall Medical) were placed bet...

  • in vitro comparison of heliox and oxygen in aerosol delivery using pediatric high flow nasal cannula
    Pediatric Pulmonology, 2011
    Co-Authors: Arzu Ari, Robert Harwood, Meryl M Sheard, Patricia Dailey, James B Fink
    Abstract:

    Drug administration via high flow nasal cannula (HFNC) has been described in pediatrics but the amount of albuterol delivery with an HFNC is not known. The purpose of this study is to quantify aerosol delivery with heliox and oxygen (O(2)) in a model of pediatric ventilation. A vibrating mesh nebulizer (Aeroneb Solo, Aerogen) was placed on the inspiratory inlet of a Heated Humidifier and Heated wire circuit attached to a pediatric nasal cannula (Optiflow, Fisher & Paykel). Breathing parameters were tidal volume (V(t)) 100 ml, respiratory rate (RR) 20/min, and I-time of 1 sec. Albuterol sulfate (2.5 mg/3 ml) was administered through a pediatric HFNC with O(2) (100%) and heliox (80/20% mixture). A total of 12 runs, using O(2) and heliox were conducted at 3 and 6 L/min (n = 3). Drug was collected on an absolute filter, eluted and measured using spectrophotometry. The percent inhaled dose (mean ± SD) was similar with heliox and O(2) at 3 L/min (11.41 ± 1.54 and 10.65 ± 0.51, respectively; P = 0.465). However at 6 L/min drug deposition was ≥ 2-fold greater with heliox (5.42 ± 0.54) than O(2) (1.95 ± 0.50; P = 0.01). Using a pediatric model of HFNC, reducing delivered flow from 6 to 3 L/min increased inhaled albuterol delivery ≥ 2-fold but eliminated the increase in inhaled drug efficiency associated with heliox.

  • influence of nebulizer type position and bias flow on aerosol drug delivery in simulated pediatric and adult lung models during mechanical ventilation
    Respiratory Care, 2010
    Co-Authors: Arzu Ari, Orcin Telli Atalay, Robert Harwood, Meryl M Sheard, Essam Ali Aljamhan, James B Fink
    Abstract:

    BACKGROUND: The effectiveness of aerosol drug delivery during mechanical ventilation is influenced by the patient, ventilator, and nebulizer variables. The impact of nebulizer type, position on the ventilator circuit, and bias flow on aerosol drug delivery has not been established for different age populations. OBJECTIVE: To determine the influence of nebulizer position and bias flow with a jet nebulizer and a vibrating-mesh nebulizer on aerosol drug delivery in simulated and mechanically ventilated pediatric and adult patients. METHOD: Albuterol sulfate (2.5 mg) was nebulized with a jet nebulizer and a vibrating-mesh nebulizer, using simulated pediatric and adult lung models. The 2 nebulizer positions were: (1) jet nebulizer placed 15 cm from the Y-piece adapter, and vibrating-mesh nebulizer attached directly to the Y-piece; and (2) jet nebulizer placed prior to the Heated Humidifier with 15 cm of large-bore tubing, and vibrating-mesh nebulizer positioned at an inlet to the Humidifier. A ventilator with a Heated Humidifier and ventilator circuit was utilized in both lung models. The adult ventilator settings were VT 500 mL, PEEP 5 cm H2O, respiratory rate 20 breaths/min, peak inspiratory flow 60 L/min, and descending ramp flow waveform.ThepediatricventilatorsettingswereVT100mL,PEEP5cmH2O,respiratoryrate20breaths/ min, inspiratory time 1 s. We tested bias flows of 2 and 5 L/min. The adult and pediatric lung models used 8-mm and 5-mm inner-diameter endotracheal tubes, respectively. Each experiment was run 3 times (n 3). The albuterol sulfate was eluted from the filter and analyzed via spectrophotometry (276 nm). RESULTS: Nebulizer placement prior to the Humidifier increased drug delivery with both the jet nebulizer and the vibrating-mesh nebulizer, with a greater increase with the vibrating-mesh nebulizer. Higher bias flow reduced drug delivery. Drug delivery with the vibrating-mesh nebulizer was 2–4-fold greater than with the jet nebulizer at all positions (P < .05) in both lung models. CONCLUSION: During simulated mechanical ventilation in pediatric and

Robert Harwood - One of the best experts on this subject based on the ideXlab platform.

  • in vitro comparison of heliox and oxygen in aerosol delivery using pediatric high flow nasal cannula
    Pediatric Pulmonology, 2011
    Co-Authors: Robert Harwood, Meryl M Sheard, Patricia Dailey, James B Fink
    Abstract:

    Summary. Drug administration via high flow nasal cannula (HFNC) has been described in pediatrics but the amount of albuterol delivery with an HFNC is not known. The purpose of this study is to quantify aerosol delivery with heliox and oxygen (O2) in a model of pediatric ventilation. A vibrating mesh nebulizer (Aeroneb Solo, Aerogen) was placed on the inspiratory inlet of a Heated Humidifier and Heated wire circuit attached to a pediatric nasal cannula (Optiflow, Fisher & Paykel). Breathing parameters were tidal volume (Vt) 100 ml, respiratory rate (RR) 20/min, and I-time of 1 sec. Albuterol sulfate (2.5 mg/3 ml) was administered through a pediatric HFNC with O2 (100%) and heliox (80/20% mixture). A total of 12 runs, using O2 and heliox were conducted at 3 and 6 L/ min (n ¼ 3). Drug was collected on an absolute filter, eluted and measured using spectropho

  • in vitro comparison of heliox and oxygen in aerosol delivery using pediatric high flow nasal cannula
    Pediatric Pulmonology, 2011
    Co-Authors: Arzu Ari, Robert Harwood, Meryl M Sheard, Patricia Dailey, James B Fink
    Abstract:

    Drug administration via high flow nasal cannula (HFNC) has been described in pediatrics but the amount of albuterol delivery with an HFNC is not known. The purpose of this study is to quantify aerosol delivery with heliox and oxygen (O(2)) in a model of pediatric ventilation. A vibrating mesh nebulizer (Aeroneb Solo, Aerogen) was placed on the inspiratory inlet of a Heated Humidifier and Heated wire circuit attached to a pediatric nasal cannula (Optiflow, Fisher & Paykel). Breathing parameters were tidal volume (V(t)) 100 ml, respiratory rate (RR) 20/min, and I-time of 1 sec. Albuterol sulfate (2.5 mg/3 ml) was administered through a pediatric HFNC with O(2) (100%) and heliox (80/20% mixture). A total of 12 runs, using O(2) and heliox were conducted at 3 and 6 L/min (n = 3). Drug was collected on an absolute filter, eluted and measured using spectrophotometry. The percent inhaled dose (mean ± SD) was similar with heliox and O(2) at 3 L/min (11.41 ± 1.54 and 10.65 ± 0.51, respectively; P = 0.465). However at 6 L/min drug deposition was ≥ 2-fold greater with heliox (5.42 ± 0.54) than O(2) (1.95 ± 0.50; P = 0.01). Using a pediatric model of HFNC, reducing delivered flow from 6 to 3 L/min increased inhaled albuterol delivery ≥ 2-fold but eliminated the increase in inhaled drug efficiency associated with heliox.

  • influence of nebulizer type position and bias flow on aerosol drug delivery in simulated pediatric and adult lung models during mechanical ventilation
    Respiratory Care, 2010
    Co-Authors: Arzu Ari, Orcin Telli Atalay, Robert Harwood, Meryl M Sheard, Essam Ali Aljamhan, James B Fink
    Abstract:

    BACKGROUND: The effectiveness of aerosol drug delivery during mechanical ventilation is influenced by the patient, ventilator, and nebulizer variables. The impact of nebulizer type, position on the ventilator circuit, and bias flow on aerosol drug delivery has not been established for different age populations. OBJECTIVE: To determine the influence of nebulizer position and bias flow with a jet nebulizer and a vibrating-mesh nebulizer on aerosol drug delivery in simulated and mechanically ventilated pediatric and adult patients. METHOD: Albuterol sulfate (2.5 mg) was nebulized with a jet nebulizer and a vibrating-mesh nebulizer, using simulated pediatric and adult lung models. The 2 nebulizer positions were: (1) jet nebulizer placed 15 cm from the Y-piece adapter, and vibrating-mesh nebulizer attached directly to the Y-piece; and (2) jet nebulizer placed prior to the Heated Humidifier with 15 cm of large-bore tubing, and vibrating-mesh nebulizer positioned at an inlet to the Humidifier. A ventilator with a Heated Humidifier and ventilator circuit was utilized in both lung models. The adult ventilator settings were VT 500 mL, PEEP 5 cm H2O, respiratory rate 20 breaths/min, peak inspiratory flow 60 L/min, and descending ramp flow waveform.ThepediatricventilatorsettingswereVT100mL,PEEP5cmH2O,respiratoryrate20breaths/ min, inspiratory time 1 s. We tested bias flows of 2 and 5 L/min. The adult and pediatric lung models used 8-mm and 5-mm inner-diameter endotracheal tubes, respectively. Each experiment was run 3 times (n 3). The albuterol sulfate was eluted from the filter and analyzed via spectrophotometry (276 nm). RESULTS: Nebulizer placement prior to the Humidifier increased drug delivery with both the jet nebulizer and the vibrating-mesh nebulizer, with a greater increase with the vibrating-mesh nebulizer. Higher bias flow reduced drug delivery. Drug delivery with the vibrating-mesh nebulizer was 2–4-fold greater than with the jet nebulizer at all positions (P < .05) in both lung models. CONCLUSION: During simulated mechanical ventilation in pediatric and

  • Influence of nebulizer type, position, and bias flow on aerosol drug delivery in simulated pediatric and adult lung models during mechanical ventilation
    2010
    Co-Authors: Arzu Ari, Robert Harwood, Phd Rrt, Pt Cpft, Orcin Telli, Msa Rrt, Essam Aljamhan Msc A Rrt
    Abstract:

    BACKGROUND: The effectiveness of aerosol drug delivery during mechanical ventilation is in-fluenced by the patient, ventilator, and nebulizer variables. The impact of nebulizer type, position on the ventilator circuit, and bias flow on aerosol drug delivery has not been established for different age populations. OBJECTIVE: To determine the influence of nebulizer position and bias flow with a jet nebulizer and a vibrating-mesh nebulizer on aerosol drug delivery in simulated and mechanically ventilated pediatric and adult patients. METHOD: Albuterol sulfate (2.5 mg) was nebulized with a jet nebulizer and a vibrating-mesh nebulizer, using simulated pediatric and adult lung models. The 2 nebulizer positions were: (1) jet nebulizer placed 15 cm from the Y-piece adapter, and vibrating-mesh nebulizer attached directly to the Y-piece; and (2) jet nebulizer placed prior to the Heated Humidifier with 15 cm of large-bore tubing, and vibrating-mesh nebulizer positioned at an inlet to the Humidifier. A ventilator with a Heated Humidifier and ventilator circuit was utilized in both lung models. The adult ventilator settings were VT 500 mL, PEEP 5 cm H2O, respiratory rate 20 breaths/min, peak inspiratory flow 60 L/min, and descending ramp flow wave-form. The pediatric ventilator settings were VT 100 mL, PEEP 5 cm H2O, respiratory rate 20 breaths/ min, inspiratory time 1 s. We tested bias flows of 2 and 5 L/min. The adult and pediatric lun

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  • in vitro comparison of heliox and oxygen in aerosol delivery using pediatric high flow nasal cannula
    Pediatric Pulmonology, 2011
    Co-Authors: Robert Harwood, Meryl M Sheard, Patricia Dailey, James B Fink
    Abstract:

    Summary. Drug administration via high flow nasal cannula (HFNC) has been described in pediatrics but the amount of albuterol delivery with an HFNC is not known. The purpose of this study is to quantify aerosol delivery with heliox and oxygen (O2) in a model of pediatric ventilation. A vibrating mesh nebulizer (Aeroneb Solo, Aerogen) was placed on the inspiratory inlet of a Heated Humidifier and Heated wire circuit attached to a pediatric nasal cannula (Optiflow, Fisher & Paykel). Breathing parameters were tidal volume (Vt) 100 ml, respiratory rate (RR) 20/min, and I-time of 1 sec. Albuterol sulfate (2.5 mg/3 ml) was administered through a pediatric HFNC with O2 (100%) and heliox (80/20% mixture). A total of 12 runs, using O2 and heliox were conducted at 3 and 6 L/ min (n ¼ 3). Drug was collected on an absolute filter, eluted and measured using spectropho

  • in vitro comparison of heliox and oxygen in aerosol delivery using pediatric high flow nasal cannula
    Pediatric Pulmonology, 2011
    Co-Authors: Arzu Ari, Robert Harwood, Meryl M Sheard, Patricia Dailey, James B Fink
    Abstract:

    Drug administration via high flow nasal cannula (HFNC) has been described in pediatrics but the amount of albuterol delivery with an HFNC is not known. The purpose of this study is to quantify aerosol delivery with heliox and oxygen (O(2)) in a model of pediatric ventilation. A vibrating mesh nebulizer (Aeroneb Solo, Aerogen) was placed on the inspiratory inlet of a Heated Humidifier and Heated wire circuit attached to a pediatric nasal cannula (Optiflow, Fisher & Paykel). Breathing parameters were tidal volume (V(t)) 100 ml, respiratory rate (RR) 20/min, and I-time of 1 sec. Albuterol sulfate (2.5 mg/3 ml) was administered through a pediatric HFNC with O(2) (100%) and heliox (80/20% mixture). A total of 12 runs, using O(2) and heliox were conducted at 3 and 6 L/min (n = 3). Drug was collected on an absolute filter, eluted and measured using spectrophotometry. The percent inhaled dose (mean ± SD) was similar with heliox and O(2) at 3 L/min (11.41 ± 1.54 and 10.65 ± 0.51, respectively; P = 0.465). However at 6 L/min drug deposition was ≥ 2-fold greater with heliox (5.42 ± 0.54) than O(2) (1.95 ± 0.50; P = 0.01). Using a pediatric model of HFNC, reducing delivered flow from 6 to 3 L/min increased inhaled albuterol delivery ≥ 2-fold but eliminated the increase in inhaled drug efficiency associated with heliox.

  • influence of nebulizer type position and bias flow on aerosol drug delivery in simulated pediatric and adult lung models during mechanical ventilation
    Respiratory Care, 2010
    Co-Authors: Arzu Ari, Orcin Telli Atalay, Robert Harwood, Meryl M Sheard, Essam Ali Aljamhan, James B Fink
    Abstract:

    BACKGROUND: The effectiveness of aerosol drug delivery during mechanical ventilation is influenced by the patient, ventilator, and nebulizer variables. The impact of nebulizer type, position on the ventilator circuit, and bias flow on aerosol drug delivery has not been established for different age populations. OBJECTIVE: To determine the influence of nebulizer position and bias flow with a jet nebulizer and a vibrating-mesh nebulizer on aerosol drug delivery in simulated and mechanically ventilated pediatric and adult patients. METHOD: Albuterol sulfate (2.5 mg) was nebulized with a jet nebulizer and a vibrating-mesh nebulizer, using simulated pediatric and adult lung models. The 2 nebulizer positions were: (1) jet nebulizer placed 15 cm from the Y-piece adapter, and vibrating-mesh nebulizer attached directly to the Y-piece; and (2) jet nebulizer placed prior to the Heated Humidifier with 15 cm of large-bore tubing, and vibrating-mesh nebulizer positioned at an inlet to the Humidifier. A ventilator with a Heated Humidifier and ventilator circuit was utilized in both lung models. The adult ventilator settings were VT 500 mL, PEEP 5 cm H2O, respiratory rate 20 breaths/min, peak inspiratory flow 60 L/min, and descending ramp flow waveform.ThepediatricventilatorsettingswereVT100mL,PEEP5cmH2O,respiratoryrate20breaths/ min, inspiratory time 1 s. We tested bias flows of 2 and 5 L/min. The adult and pediatric lung models used 8-mm and 5-mm inner-diameter endotracheal tubes, respectively. Each experiment was run 3 times (n 3). The albuterol sulfate was eluted from the filter and analyzed via spectrophotometry (276 nm). RESULTS: Nebulizer placement prior to the Humidifier increased drug delivery with both the jet nebulizer and the vibrating-mesh nebulizer, with a greater increase with the vibrating-mesh nebulizer. Higher bias flow reduced drug delivery. Drug delivery with the vibrating-mesh nebulizer was 2–4-fold greater than with the jet nebulizer at all positions (P < .05) in both lung models. CONCLUSION: During simulated mechanical ventilation in pediatric and