Lung deposition and systemic bioavailability of different aerosol devices with and without humidification in mechanically ventilated patients

• Published in: Heart & lung Vol. 46; no. 6; pp. 464 - 467
• Main Authors: Moustafa, Islam O.F., Ali, Mohammed R. A.-A., Al Hallag, Moataz, Rabea, Hoda, Fink, James B., Dailey, Patricia, Abdelrahim, Mohamed E.A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2017
• Subjects: Administration, Inhalation; Aerosols - administration & dosage; Aerosols - pharmacokinetics; Albuterol - administration & dosage; Albuterol - pharmacokinetics; Biological Availability; Bronchodilator Agents - administration & dosage; Bronchodilator Agents - pharmacokinetics; Cross-Over Studies; Equipment Design; Female; Humans; Humidification; Humidifiers - utilization; Lung - metabolism; Male; MDI; Metered Dose Inhalers; Middle Aged; Non-invasive ventilation; Respiration, Artificial - methods; Spacer; Urinary salbutamol; Vibrating mesh nebulizers; MDI; Urinary salbutamol; Humidification; Vibrating mesh nebulizers; Non-invasive ventilation; Spacer
• ISSN: 0147-9563; 1527-3288; 1527-3288
• DOI: 10.1016/j.hrtlng.2017.08.004

During mechanical ventilation medical aerosol delivery has been reported to be upto two fold greater with dry inhaled gas than with heated humidity. Urine levels at 0.5 h post dose (URSAL0.5%) has been confirmed as an index of lung deposition and 24 h (URSAL24%) as index of systemic absorption. Our aim was to determine the effect of humidification and aerosol device type on drug delivery to ventilated patients using urine levels. In a randomized crossover design, 36 (18female) mechanically ventilated patients were assigned to one of three groups. Groups 1 and 2 received 5000 μg salbutamol using vibrating mesh (VM) and jet nebulizers (JN), respectively, while group 3 received 1600 μg (16 puffs) of salbutamol via metered dose inhaler with AeroChamber Vent (MDI-AV). All devices were placed in the inspiratory limb of ventilator downstream from the humidifier. Each subject received aerosol with and without humidity at >24 h intervals with >12 h washout periods between salbutamol doses. Patients voided urine 15 min before each study dose and urine samples were collected at 0.5 h post dosing and pooled for the next 24 h. The MDI-AV and VM resulted in a higher percentage of urinary salbutamol levels compared to the JN (p < 0.05). Urine levels were similar between humidity and dry conditions. Our findings suggest that in-vitro reports overestimate the impact of dry vs. heated humidified conditions on the delivery of aerosol during invasive mechanical ventilation.