Abstract
BackgroundFew studies have investigated the factors affecting aerosol delivery during non-invasive ventilation (NIV). Our aim was to investigate, using a bench-top model, the effect of different ventilator settings and positions of the exhalation port and nebulizer on the amount of albuterol delivered to a lung simulator.MethodsA lung model simulating spontaneous breathing was connected to a single-limb NIV ventilator, set in bi-level positive airway pressure (BIPAP) with inspiratory/expiratory pressures of 10/5, 15/10, 15/5, and 20/10 cmH2O, or continuous positive airway pressure (CPAP) of 5 and 10 cmH2O. Three delivery circuits were tested: a vented mask with the nebulizer directly connected to the mask, and an unvented mask with a leak port placed before and after the nebulizer. Albuterol was collected on a filter placed after the mask and then the delivered amount was measured with infrared spectrophotometry.ResultsAlbuterol delivery during NIV varied between 6.7 ± 0.4% to 37.0 ± 4.3% of the nominal dose. The amount delivered in CPAP and BIPAP modes was similar (22.1 ± 10.1 vs. 24.0 ± 10.0%, p = 0.070). CPAP level did not affect delivery (p = 0.056); in BIPAP with 15/5 cmH2O pressure the delivery was higher compared to 10/5 cmH2O (p = 0.033) and 20/10 cmH2O (p = 0.014). Leak port position had a major effect on delivery in both CPAP and BIPAP, the best performances were obtained with the unvented mask, and the nebulizer placed between the leak port and the mask (p < 0.001).ConclusionsIn this model, albuterol delivery was marginally affected by ventilatory settings in NIV, while position of the leak port had a major effect. Nebulizers should be placed between an unvented mask and the leak port in order to maximize aerosol delivery.
Highlights
Few studies have investigated the factors affecting aerosol delivery during non-invasive ventilation (NIV)
Our goal was to investigate, with a bench-top model, the effect of different positions of the exhalation port and nebulizer during continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BIPAP) administered with a dedicated NIV ventilator on aerosol delivery
The ventilator was set in CPAP or BIPAP mode, in the latter case with a rise time of 0.2 s and the inspiratory trigger sensitivity set at −2 L/m
Summary
Few studies have investigated the factors affecting aerosol delivery during non-invasive ventilation (NIV). Our aim was to investigate, using a bench-top model, the effect of different ventilator settings and positions of the exhalation port and nebulizer on the amount of albuterol delivered to a lung simulator. Non-invasive positive pressure ventilation (NIV) is being used increasingly in patients with either acute or chronic respiratory failure [1]. NIV can be delivered through several interfaces: the most commonly used oro-nasal and nasal masks have a built-in leak port, but this design resulted in reduced albuterol delivery in in-vitro studies [11, 12]. Our goal was to investigate, with a bench-top model, the effect of different positions of the exhalation port and nebulizer during CPAP or BIPAP administered with a dedicated NIV ventilator on aerosol delivery. We hypothesized that albuterol delivery by nebulization during NIV is affected by the positions of the exhalation port and pressure levels
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