COMBINED BOLUS AND CONTINUOUS NEBULIZATION DURING MECHANICAL VENTILATION: DUAL THERAPY FOR RESPIRATORY FAILURE

Abstract

TYPE: Abstract TOPIC: Critical Care PURPOSE: This study tests nebulizers configured to deliver multiple medications during continuous nebulization without interruption or circuit disconnection. METHODS: A prototype i-AIRE dual-medication port breath-enhanced jet nebulizer (BEJN) was compared to Aerogen Solo vibrating mesh nebulizers (VMN). VMN were stacked; one for infusion, the second for bolus drug delivery. Radiolabeled saline was infused over 4 hr at 5 & 10 mL/h with 3 mL and 6 mL radiolabeled saline bolus injections into the circuit at 30 and 120 min respectively. Inhaled Mass expressed as % of initial syringe activity (IM%/min) was monitored in real time with a ratemeter. All delivered radioaerosol was collected on a filter at the airway opening. Transients in aerosol delivery were documented. RESULTS: IM %/h during continuous infusion was linear, with BEJN and VMN delivering 3-4 %/hr. BEJN functioned without incident. VMN stopped nebulizing spontaneously 50% of the time but tapping restarted VMN function during 3 of 4 continuous runs and 7 of 9 bolus delivery runs. Bolus delivery IM% (mean ± SD): 22 ± 8%, 14 ± 11 % for BEJN and VMN, respectively. CONCLUSIONS: Simultaneous continuous and bolus nebulization without circuit disconnection is possible for both jet and mesh technology. CLINICAL IMPLICATIONS: Continuous nebulization of pulmonary vasodilators is an off-label therapy for critically ill patients with hypoxemia. This study indicates that additional drugs (bronchodilators/antibiotics) can be given by bolus nebulization without circuit disconnection. Monitoring of VMN devices may be necessary in case of spontaneous interruption of nebulization. DISCLOSURE: Stony Brook University owns patents on inhaled therapy in intubated patients licensed to InspiRx, Inc. Dr. Smaldone consults to InspiRx and is a member of the Advisory Board. Ms Cuccia has served as a consultant to InspiRx. Dr. Lee and Mr. McPeck have no KEYWORD: nebulization