EVALUATION OF AEROSOL DRUG DELIVERY DURING MANUAL RESUSCITATION IN ADULT AND PEDIATRIC PATIENTS

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The aim of this study was to compare the aerosol delivery from a vibrating mesh nebuliser (VMN) and a jet nebuliser (JN) using a manual resuscitation bag (MRB) in adult and pediatric patients. METHODS: A 2.5ml dose of 1mg/ml of salbutamol (GlaxoSmithKline Ltd., Ireland) was aerosolised as a tracer aerosol with a VMN (Aerogen Solo, Aerogen, Ireland) and a JN (Philips SideStream, Philips, Netherlands). The JN was operated at a standard driving gas flow rate of 7 LPM and run until sputter + 1 minute for each test scenario. The nebulisers were placed distal to an endotracheal tube, (ETT) (adult ID 8.0mm, paediatric ID 5.0mm, Flexicare Medical Ltd, UK). The respiratory circuit was driven by an MRB (Ventlab Airflow 1500ml adult and 550ml paediatric MRB, SunMed LLC, USA) at a rate of 20 BPM and an inspiratory:expiratory ratio (I:E) of 1:2 for both patient cohorts. These breathing rates are on the upper and lower end of the ranges for adult and paediatric patients; however, a BR of 20 BPM and an I:E of 1:2 is considered normal in both patient types [2]. To ensure consistency of dose delivery the same user operated the MRB for each test. A capture filter (Respigard, Baxter, Ireland) was placed between the ETT and a test lung (IMT SmartLung, IMT Analytics, Switzerland). The mass of drug delivered was determined using UV spectrophotometry at 276nm. Results, indicating the dose delivered to the patient, are expressed as the percentage of the nominal dose placed in the nebuliser’s medication cup. A paired t-test analysis was carried out to determine significance of results. Significance was considered at p≤0.05. RESULTS: The use of the VMN resulted in a higher delivered lung dose (%) compared to the JN when used in combination with both the adult (13.19% ± 0.63% VMN versus 3.05% ± 0.33% JN, p = 0.00) and pediatric (3.13% ± 0.34% VMN versus 1.17% ± 0.31% JN, p = 0.034) resuscitation bags. CONCLUSIONS: These findings indicate that the nebuliser type had a significant effect on the efficiency of aerosol delivery to an intubated patient using an MRB, p≤0.05. The VMN delivered significantly more aerosol than the JN in both adult and pediatric patients. CLINICAL IMPLICATIONS: Manual resuscitation plays a pivotal role in airway management and potentially in determining patient outcomes [1]. Medical aerosols can be administered to a patient to stabilize the airways and can be delivered in combination with a manual resuscitation bag. The choice of nebuliser may influence the efficiency of aerosol delivered to the patient.