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Patrice Diot - One of the best experts on this subject based on the ideXlab platform.
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Aerosol Route to Administer Teicoplanin in Mechanical Ventilation: In Vitro Study, Lung Deposition and Pharmacokinetic Analyses in Pigs
JOURNAL OF AEROSOL MEDICINE AND PULMONARY DRUG DELIVERY, 2015Co-Authors: Antoine Guillon, Emmanuelle Mercier, Philippe Lanotte, Eve Haguenoer, François Darrouzain, Celine Barc, Pierre Sarradin, Mustapha Si-tahar, Nathalie Heuzé-vourc'h, Patrice DiotAbstract:Backround: Glycopeptides given intravenously achieve low airway concentrations. Nebulization of teicoplanin may be an efficient way of delivering a high concentration of this antibiotic to the lung. This multistep study assessed the feasibility of teicoplanin nebulization during mechanical ventilation by evaluating: the stability of its antibiotic effect; epithelial tolerance; lung deposition and systemic absorption in ventilated pigs. Nebulized and non-nebulized teicoplanin activity was tested on Staphylococcus aureus cultures. The cytotoxic effect of teicoplanin on human respiratory epithelial cells was assessed by measuring lactate dehydrogenase activity released, cell viability, and transepithelial electrical resistance. Volume median diameter of particles of nebulized teicoplanin was measured by laser diffraction during mechanical ventilation. The deposited mass of teicoplanin nebulized with a vibrating mesh Nebulizer in ventilated piglets was assessed by scintigraphy. Blood pharmacokinetics of teicoplanin administered either intravenously or by nebulization was compared. No decrease of antibiotic activity was observed after nebulization. In vitro cytotoxicity of teicoplanin was only observed with 1000 times the dose recommended for intravenous administration. Volume median diameter of particles was 2.5±0.1 μm. Of the initial Nebulizer charge of teicoplanin, 24±7% was present in the lungs of ventilated pigs after the nebulization. Amount absorbed in blood was low (3.4%±0.9%) after nebulization, and blood stream elimination half-life value was 25.4 h. Teicoplanin was administered efficiently by nebulization during mechanical ventilation, without any effect on its pharmacological properties or any cytotoxicity. The pharmacokinetic parameters are promising in view of its time-dependent killing process. All the results of our multi-step study highlighted the potential of teicoplanin to be nebulized during mechanical ventilation.
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Aerodynamical, Immunological and Pharmacological Properties of the Anticancer Antibody Cetuximab Following Nebulization
Pharmaceutical Research, 2008Co-Authors: Agnès Maillet, Laurent Vecellio, Nicolas Congy-jolivet, Sandrine Le Guellec, Sophie Hamard, Yves Courty, Anthony Courtois, Francis Gauthier, Patrice Diot, Gilles ThibaultAbstract:Purpose Despite an increasing interest in the use of inhalation for local delivery of molecules for respiratory diseases and systemic disorders, methods to deliver therapy through airways has received little attention for lung cancer treatment. However, inhalation of anticancer drugs is an attractive alternative route to systemic administration which results in limited concentration of the medication in the lungs, and triggers whole-body toxicity. In this study, we investigated the feasibility of nebulization for therapeutic antibodies, a new class of fully-approved anticancer drugs in oncology medicine. Materials and methods Cetuximab, a chimeric IgG1 targeting the epidermal growth factor receptor (EGFR), was nebulized using three types of delivery devices: a jet Nebulizer PARI LC+®, a mesh Nebulizer AeronebPro® and an ultrasonic Nebulizer SYST’AM® LS290. Aerosol size distribution was measured using a cascade impactor and aerosol droplets were observed under optical microscopy. The immunological and pharmacological properties of cetuximab were evaluated following nebulization using A431 cells. Results The aerosol particle clouds generated with the three Nebulizers displayed similar aerodynamical characteristics, but the IgG formed aggregates in liquid phase following nebulization with both the jet and ultrasonic devices. Flow cytometry analyses and assays of EGFR-phosphorylation and cell growth inhibitions on A431 demonstrated that both the mesh and the jet Nebulizers preserved the binding affinity to EGFR and the inhibitory activities of cetuximab. Conclusions Altogether, our results indicate that cetuximab resists the physical constraints of nebulization. Thus, airway delivery represents a promising alternative to systemic administration for local delivery of therapeutic antibodies in lung cancer treatment.
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Aerosol Deposition in Neonatal Ventilation
Pediatric Research, 2005Co-Authors: Jean C Dubus, Laurent Vecellio, Jerome Montharu, Michele De Monte, James B Fink, Daniel Grimbert, Chantal Valat, Neil Behan, Patrice DiotAbstract:Lung deposition of inhaled drugs in ventilated neonates has been studied in models of questionable relevance. With conventional Nebulizers, pulmonary deposition has been limited to 1% of the total dose. The objective of this study was to assess lung delivery of aerosols in a model of neonatal ventilation using a conventional and novel electronic micropump Nebulizer. Aerosol deposition studies with 99mTc diethylenetriamine pentaacetate (99mTc-DTPA) were performed in four macaques (2.6 kg) that were ventilated through a 3.0-mm endotracheal tube (with neonatal settings (peak inspiratory pressure 12–14 mbar, positive end-expiratory pressure 2 mbar, I/E ratio 1/2, respiratory rate 40/min), comparing a jet-Nebulizer MistyNeb (3-mL charge, 4.8 μm), an electronic micropump Nebulizer operating continuously [Aeroneb Professional Nebulizer (APN-C); 0.5-mL charge, 4.6 μm], and another synchronized with inspiration [Aeroneb Professional Nebulizer Synchronized (APN-S); 0.5-mL charge, 2.8 μm]. The amount of radioactivity deposited into lungs and connections and remaining in the Nebulizer was measured by a gamma counter. Despite similar amounts of 99mTc-DTPA in the respiratory circuit with all Nebulizers, both APN-S and APN-C delivered more drug to the lungs than MistyNeb (14.0, 12.6, and 0.5% in terms of percentage of Nebulizer charge, respectively; p = 0.006). Duration of delivery was shorter with APN-C than with the two other Nebulizers (2 versus 6 and 10 min for the APN-S and the MistyNeb, respectively; p < 0.001). Electronic micropump Nebulizers are more efficient to administer aerosols in an animal model of ventilated neonates. Availability of Aerogen's electronic micropump Nebulizers offers new opportunities to study clinical efficacy and risks of aerosol therapy in ventilated neonates.
Gerald C Smaldone - One of the best experts on this subject based on the ideXlab platform.
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omron ne u22 comparison between vibrating mesh and jet Nebulizer
Journal of Aerosol Medicine and Pulmonary Drug Delivery, 2010Co-Authors: Shibu Skaria, Gerald C SmaldoneAbstract:Abstract Background: To overcome the limitations of conventional jet Nebulizers, vibrating mesh technology has been commercialized. The present article is designed to address clinically relevant issues for routine aerosol therapy for a vibrating mesh Nebulizer, the Omron NE U22, compared to traditional jet Nebulizers. Methods: Inhaled mass (IM), residual activity, particle distribution, including mass median aerodynamic diameter (MMAD) and run time, were determined for radiolabeled albuterol (2.5 mg/3 mL). Omron NE U22, Pari LC Plus, and Sidestream Nebulizers were tested. The Omron was tested in two positions, tilted and horizontal. Finally robustness of the Omron NE U22 was determined by repeating treatment 60 times. All Omron experiments were performed using continuous operation. Results: IM for Omron and Pari were similar (20% of Nebulizer charge) and greater than the Sidestream (10%). MMADs were similar for all devices but variability was much greater for Omron in the horizontal position. Run time in ...
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aerosol deposition in mechanically ventilated patients optimizing Nebulizer delivery
American Journal of Respiratory and Critical Care Medicine, 1994Co-Authors: Thomas G Oriordan, Lucy B Palmer, Gerald C SmaldoneAbstract:Previous studies have suggested that Nebulizers are inefficient in delivering aerosolized medication to the lung in patients supported by mechanical ventilation. In a recent bench study, we characterized factors that may affect aerosol delivery, i.e., Nebulizer type, ventilator settings (duty cycle), volume fill, and humidification as well as technical factors affecting measurement of deposition (e.g., radiolabeled compounds). Utilizing the predictions from our bench data, the present study was designed to assess nebulized aerosol delivery to ventilated patients under optimal conditions. Seven patients who were receiving mechanical ventilation (Bear II) via tracheostomy tube (TT) were studied. The humidifier was turned off. The test aerosol, a saline solution labeled with 99mTechnetium bound to human serum albumin (99mTc-HSA), was administered via a jet Nebulizer (AeroTech II, 1.1 +/- 1.8 microns [mass median aerodynamic diameter, MMAD, geometric standard deviation, sigma g]), which was incorporated into ...
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aerosol deposition in mechanically ventilated patients optimizing Nebulizer delivery
The American review of respiratory disease, 1994Co-Authors: Thomas G Oriordan, Lucy B Palmer, Gerald C SmaldoneAbstract:Previous studies have suggested that Nebulizers are inefficient in delivering aerosolized medication to the lung in patients supported by mechanical ventilation. In a recent bench study, we characterized factors that may affect aerosol delivery, i.e., Nebulizer type, ventilator settings (duty cycle), volume fill, and humidification as well as technical factors affecting measurement of deposition (e.g., radiolabeled compounds). Utilizing the predictions from our bench data, the present study was designed to assess nebulized aerosol delivery to ventilated patients under optimal conditions. Seven patients who were receiving mechanical ventilation (Bear II) via tracheostomy tube (TT) were studied. The humidifier was turned off
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Nebulizer function during mechanical ventilation
The American review of respiratory disease, 1992Co-Authors: Thomas G Oriordan, Mark J Greco, Robert J Perry, Gerald C SmaldoneAbstract:In the setting of mechanical ventilation, recent studies have cast doubt on the ability of Nebulizer systems to deliver adequate amounts of medication. We therefore studied ventilator-related and Nebulizer-related factors that could potentially affect the amount of aerosol inhaled by an intubated subject. Utilizing two separate protocols, we used a bench model of a ventilator circuit, radiolabeled (technetium pertechnetate, 99mTc) saline droplets and a filter technique to measure the percentage of radioaerosol delivered. First, we compared four commercially available jet Nebulizers and found that there were significant differences in rate of aerosol production between systems, ranging from 3 to 37%. Delivered aerosol was measured at different ventilator settings, and it was found that the duty cycle can potentially influence output by sevenfold. Some Nebulizers were also sensitive to changes in the initial volume of solution placed in the Nebulizer. The inclusion of a humidification device significantly reduced output by a mean of 41 +/- 3.5%, but it did not affect particle distribution. Endotracheal tube diameter was not an important variable. Then, with the effects of the above variables established, a separate series of experiments was performed to test whether the use of different radiolabeling compounds can confound the measurement of inhaled drugs. Two Nebulizers (AeroTech II and Twin Jet) and pentamidine as the test drug were studied with fixed ventilator settings, treatment time, endotracheal tube size, and volume fill. No humidification was used. The Nebulizer solution was labeled with 99mTc, which was bound to either human serum albumin (HSA) or sulfur colloid (SC).(ABSTRACT TRUNCATED AT 250 WORDS)
Kevin M G Taylor - One of the best experts on this subject based on the ideXlab platform.
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air jet and vibrating mesh nebulization of niosomes generated using a particulate based proniosome technology
International Journal of Pharmaceutics, 2013Co-Authors: Abdelbary Elhissi, Kevin M G Taylor, Kanar Hidayat, David Andrew Phoenix, Enosh Mwesigwa, St John Crean, Waqar Ahmed, Ahmed FaheemAbstract:Abstract The aerosol properties of niosomes were studied using Aeroneb Pro and Omron MicroAir vibrating-mesh Nebulizers and Pari LC Sprint air-jet Nebulizer. Proniosomes were prepared by coating sucrose particles with Span 60 (sorbitan monostearate), cholesterol and beclometasone dipropionate (BDP) (1:1:0.1). Nano-sized niosomes were produced by manual shaking of the proniosomes in deionized water followed by sonication (median size 236 nm). The entrapment of BDP in proniosome-derived niosomes was higher than that in conventional thin film-made niosomes, being 36.4% and 27.5% respectively. All Nebulizers generated aerosols with very high drug output, which was 83.6% using the Aeroneb Pro, 85.5% using the Pari and 72.4% using the Omron. The median droplet size was 3.32 μm, 3.06 μm and 4.86 μm for the Aeroneb Pro, Pari and Omron Nebulizers respectively and the “fine particle fraction” (FPF) of BDP was respectively 68.7%, 76.2% and 42.1%. The predicted extrathoracic deposition, based on size distribution of nebulized droplets was negligible for all devices, suggesting all of them are potentially suitable for pulmonary delivery of niosomes. The predicted drug deposition in the alveolar region was low using the Omron (3.2%), but greater using the Aeroneb Pro (17.4%) and the Pari (20.5%). Overall, noisome-BDP aerosols with high drug output and FPF can be generated from proniosomes and delivered using vibrating-mesh or air-jet Nebulizers.
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nebulization of fluids of different physicochemical properties with air jet and ultrasonic Nebulizers
Pharmaceutical Research, 1995Co-Authors: Orla N M Mccallion, Kevin M G Taylor, M Thomas, A J TaylorAbstract:PURPOSE: Empirical formulae relate the mean size of primary droplets from jet and ultrasonic Nebulizers to a fluid's physicochemical properties. Although the size selective "filtering" effects of baffling and evaporation may modify the secondary aerosol produced, this research sought to evaluate whether viscosity and surface tension of nebulized fluids influenced the aerosol's size and output characteristics. METHODS: Fluid systems of different surface tension and viscosity (glycerol and propylene glycol solutions [10-50% (v/v)] and a range of silicone fluids [200/0.65 cs-100cs]) were nebulized in three jet and two ultrasonic Nebulizers. Secondary aerosol characteristics were measured with a Malvern 2600C laser diffraction sizer and the nebulization times, residual volumes and percentage outputs were determined. RESULTS: While the droplet size appeared to be inversely proportional to viscosity for jet Nebulizers, it was directly proportional to viscosity for ultrasonic Nebulizers. Although fluid systems with lower surface tensions generally produced slightly smaller MMDs, the relationship between surface tension and droplet size was complex. The more viscous fluids required longer nebulization times and were associated with increased residual amounts (lower outputs). The ultrasonic Nebulizers did not effectively, and were on occasion unable to, nebulize the more viscous fluids. CONCLUSIONS: It follows that there are cut-off values for viscosity and/or surface tension above or below which ultrasonic devices fail to operate. Moreover, jet Nebulizers generated an aerosol with an optimum respirable output from median-viscosity fluids.
Laurent Vecellio - One of the best experts on this subject based on the ideXlab platform.
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disposable versus reusable jet Nebulizers for cystic fibrosis treatment with tobramycin
Journal of Cystic Fibrosis, 2011Co-Authors: Laurent Vecellio, Mohamed E A Abdelrahim, Jerome Montharu, Julien Galle, P Diot, J C DubusAbstract:Abstract Background Jet Nebulizers are commonly used to administer aerosolized tobramycin to CF patients. The aim of this study was to assess the performance of disposable jet Nebulizers as an alternative to reusable Nebulizers such as the Pari LC Plus. Method From a survey conducted in 49 CF centers in France, 18 disposable jet Nebulizer systems were selected. An in vitro study was performed with 20 jet Nebulizer/air source combinations (18 disposable and 2 reusable) to determine their performance with tobramycin solution (300mg/5mL). A scintigraphic deposition study in baboons was performed to validate the in vitro data. Results In vitro and in vivo results correlated. There was no overall relationship between the compressed air source and Nebulizer performance, but the Nebulizer interface was responsible for significantly different results. Conclusions None of the disposable Nebulizers tested in this study can be recommended as an alternative to the Pari LC Plus Nebulizer for tobramycin.
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Delivery Efficacy of a Vibrating Mesh Nebulizer and a Jet Nebulizer under Different Configurations
Journal of Aerosol Medicine and Pulmonary Drug Delivery, 2010Co-Authors: Laurent Pitance, Laurent Vecellio, Teresinha Leal, Gregory Reychler, Hervé Reychler, Giuseppe LiistroAbstract:Abstract Background: Jet Nebulizers coupled to spacers are frequently used to promote drug lung deposition, but their clinical efficacy has not been established. Few in vivo studies have been performed with mesh Nebulizers, commonly used to nebulize antibiotics. Our study compared inhaled mass and urinary drug concentration of amikacin by using three different Nebulizer delivery configuration systems: a standard unvented jet Nebulizer (Sidestream®) used alone or coupled to a 110-mL corrugated piece of tubing and a vibrating mesh Nebulizer (e-Flow rapid®). Method: The inhaled mass of amikacin was assessed using the residual gravimetric method. Delivery efficacy was evaluated by assessing amikacin urinary drug concentration in six healthy spontaneously breathing volunteers. Urinary amikacin was monitored by fluorescent polarization immunoassay then cumulative excreted amount and antibiotic elimination rate were calculated. Results and Conclusions: The total daily amount of amikacin urinary excretion (Cu) wa...
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Delivery Efficacy of a Vibrating Mesh Nebulizer and a Jet Nebulizer under Different Configurations
Journal of Aerosol Medicine and Pulmonary Drug Delivery, 2010Co-Authors: Laurent Pitance, Laurent Vecellio, Teresinha Leal, Gregory Reychler, Hervé Reychler, Giuseppe LiistroAbstract:BACKGROUND: Jet Nebulizers coupled to spacers are frequently used to promote drug lung deposition, but their clinical efficacy has not been established. Few in vivo studies have been performed with mesh Nebulizers, commonly used to nebulize antibiotics. Our study compared inhaled mass and urinary drug concentration of amikacin by using three different Nebulizer delivery configuration systems: a standard unvented jet Nebulizer (Sidestream(®)) used alone or coupled to a 110-mL corrugated piece of tubing and a vibrating mesh Nebulizer (e-Flow rapid(®)). METHOD: The inhaled mass of amikacin was assessed using the residual gravimetric method. Delivery efficacy was evaluated by assessing amikacin urinary drug concentration in six healthy spontaneously breathing volunteers. Urinary amikacin was monitored by fluorescent polarization immunoassay then cumulative excreted amount and antibiotic elimination rate were calculated. RESULTS AND CONCLUSIONS: The total daily amount of amikacin urinary excretion (Cu) was almost twice as high with eFlow rapid(®) compared to Sidestream(®) used alone; intermediate values being observed when the device was coupled to a corrugated piece of tubing. The latter configuration was also associated with a higher total daily amount of amikacin urinary excretion. In vivo drug output rate was around threefold higher with the eFlow Rapid(®) than with the Sidestream(®) used in any configuration. These results were concordant to those obtained with in vitro analysis comparing inhaled mass of amikacin for the three Nebulizers. The elimination constant (Ke) and the mass median aerodynamic diameter (MMAD) did not differ between the three devices. In conclusion, the vibrating mesh Nebulizer is more efficient, promoting larger urinary drug concentration and drug output. Coupling a corrugated piece of tubing to the standard jet Nebulizer favors delivery efficacy.
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Aerodynamical, Immunological and Pharmacological Properties of the Anticancer Antibody Cetuximab Following Nebulization
Pharmaceutical Research, 2008Co-Authors: Agnès Maillet, Laurent Vecellio, Nicolas Congy-jolivet, Sandrine Le Guellec, Sophie Hamard, Yves Courty, Anthony Courtois, Francis Gauthier, Patrice Diot, Gilles ThibaultAbstract:Purpose Despite an increasing interest in the use of inhalation for local delivery of molecules for respiratory diseases and systemic disorders, methods to deliver therapy through airways has received little attention for lung cancer treatment. However, inhalation of anticancer drugs is an attractive alternative route to systemic administration which results in limited concentration of the medication in the lungs, and triggers whole-body toxicity. In this study, we investigated the feasibility of nebulization for therapeutic antibodies, a new class of fully-approved anticancer drugs in oncology medicine. Materials and methods Cetuximab, a chimeric IgG1 targeting the epidermal growth factor receptor (EGFR), was nebulized using three types of delivery devices: a jet Nebulizer PARI LC+®, a mesh Nebulizer AeronebPro® and an ultrasonic Nebulizer SYST’AM® LS290. Aerosol size distribution was measured using a cascade impactor and aerosol droplets were observed under optical microscopy. The immunological and pharmacological properties of cetuximab were evaluated following nebulization using A431 cells. Results The aerosol particle clouds generated with the three Nebulizers displayed similar aerodynamical characteristics, but the IgG formed aggregates in liquid phase following nebulization with both the jet and ultrasonic devices. Flow cytometry analyses and assays of EGFR-phosphorylation and cell growth inhibitions on A431 demonstrated that both the mesh and the jet Nebulizers preserved the binding affinity to EGFR and the inhibitory activities of cetuximab. Conclusions Altogether, our results indicate that cetuximab resists the physical constraints of nebulization. Thus, airway delivery represents a promising alternative to systemic administration for local delivery of therapeutic antibodies in lung cancer treatment.
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Aerosol Deposition in Neonatal Ventilation
Pediatric Research, 2005Co-Authors: Jean C Dubus, Laurent Vecellio, Jerome Montharu, Michele De Monte, James B Fink, Daniel Grimbert, Chantal Valat, Neil Behan, Patrice DiotAbstract:Lung deposition of inhaled drugs in ventilated neonates has been studied in models of questionable relevance. With conventional Nebulizers, pulmonary deposition has been limited to 1% of the total dose. The objective of this study was to assess lung delivery of aerosols in a model of neonatal ventilation using a conventional and novel electronic micropump Nebulizer. Aerosol deposition studies with 99mTc diethylenetriamine pentaacetate (99mTc-DTPA) were performed in four macaques (2.6 kg) that were ventilated through a 3.0-mm endotracheal tube (with neonatal settings (peak inspiratory pressure 12–14 mbar, positive end-expiratory pressure 2 mbar, I/E ratio 1/2, respiratory rate 40/min), comparing a jet-Nebulizer MistyNeb (3-mL charge, 4.8 μm), an electronic micropump Nebulizer operating continuously [Aeroneb Professional Nebulizer (APN-C); 0.5-mL charge, 4.6 μm], and another synchronized with inspiration [Aeroneb Professional Nebulizer Synchronized (APN-S); 0.5-mL charge, 2.8 μm]. The amount of radioactivity deposited into lungs and connections and remaining in the Nebulizer was measured by a gamma counter. Despite similar amounts of 99mTc-DTPA in the respiratory circuit with all Nebulizers, both APN-S and APN-C delivered more drug to the lungs than MistyNeb (14.0, 12.6, and 0.5% in terms of percentage of Nebulizer charge, respectively; p = 0.006). Duration of delivery was shorter with APN-C than with the two other Nebulizers (2 versus 6 and 10 min for the APN-S and the MistyNeb, respectively; p < 0.001). Electronic micropump Nebulizers are more efficient to administer aerosols in an animal model of ventilated neonates. Availability of Aerogen's electronic micropump Nebulizers offers new opportunities to study clinical efficacy and risks of aerosol therapy in ventilated neonates.
Markku Turpeinen - One of the best experts on this subject based on the ideXlab platform.
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The Conventional Ultrasonic Nebulizer Proved Inefficient in Nebulizing a Suspension
Journal of Aerosol Medicine-deposition Clearance and Effects in The Lung, 1999Co-Authors: Kurt Verner Holger Nikander, Markku Turpeinen, Per WollmerAbstract:ABSTRACT A study was undertaken to compare the amount of nebulized budesonide suspension and nebulized terbutaline sulphate solution inhaled by healthy adult subjects when conventional jet and ultrasonic Nebulizers were used. Ten healthy subjects (5 male; age range, 16–52 years) used two conventional Nebulizers: the Spira Elektro 4 jet Nebulizer (Respiratory Care Center, Hameenlinna, Finland) and the Spira Ultra ultrasonic Nebulizer (Respiratory Care Center) in a breath-synchronized mode with each drug. The amount of drug inhaled, the inhaled mass, was defined as the amount of drug deposited on a filter between the inspiratory port of the Nebulizer and the mouthpiece. The amount of budesonide and terbutaline sulphate was determined by reversed-phase high-performance liquid chromatography. Single-dose respules were used (0.5 mg of budesonide and 5.0 mg of terbutaline sulphate), and nebulization time up to the defined gravimetric output was recorded. The inhaled mass of budesonide varied depending on the ne...
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jet nebulization of budesonide suspension into a neonatal ventilator circuit synchronized versus continuous Nebulizer flow
Pediatric Pulmonology, 1997Co-Authors: Anna S Pelkonen, Kurt Verner Holger Nikander, Markku TurpeinenAbstract:To determine the dose of inhaled budesonide suspension in the treatment of preterm infants with ventilator-dependent lung disease, we measured the dose of nebulized budesonide delivered through an endotracheal tube (ETT), using a test lung and filters. The effect of delivering the nebulized aerosol to two different locations in the same ventilatory circuit was evaluated. In addition, a new synchronized jet Nebulizer was tested. The median drug delivery to the test lung was 0.3% (range, 0–0.4%) of the nominal dose when the Nebulizer activated by continuous gas flow was inserted into the inspiratory line of the circuit. Drug delivery could be increased to 0.7% (range, 0.5–0.8%) by delivering the Nebulizer output directly to the ETT. When using the synchronized jet Nebulizer, drug delivery was 1.1% (range, 0.8–1.6%). The particle size of aerosol emerging from the ETT was 2.14 μm. The nebulization time with the synchronized Nebulizer set-up was 38 min, while the other set-ups delivered an equal volume of solution in 6–7 min. Drug delivery of 0.3–1.1% to the test lung illustrates the problems encountered in aerosol treatment of intubated neonates. We conclude that the delivery of budesonide to the test lung can be increased by delivering the Nebulizer output to the ETT directly. Using synchronized nebulization during inspiration only can achieve further increases in drug delivery, and wastage of drug during expiration is decreased. Synchronized nebulization may, therefore, have an important place in the delivery of expensive aerosolized drugs. Pediatr. Pulmonol. 1997;24:282–286. © 1997 Wiley-Liss, Inc.
