Fink JB, Dhand R, Grychowski J, Fahey PJ, Tobin MJ. Am J Respir Crit Care Med 1999;159(1): 63–68.

aerosol delivery from MDI during mechanical ventilation aerosol delivery from MDI during mechanical ventilation with humidified circuitwith humidified circuit

bronchibronchi

30.4%

16.2%

22.0%

12.3%

Device related-NebulizerTypeFill volume Particle size Aerosol output rate Gas flow rateCycling: Continuous or intermittent nebulizationDuration of nebulizationPosition of the aerosol device in the ventilator circuitDevice related-Metered-dose inhalerAdapter/spacer Timing of actuationType of MDI Position of the aerosol device in the ventilator circuit

Factors that affect aerosol delivery and depositionFactors that affect aerosol delivery and deposition

continuous

Mass of budesonide deposited in inspiratory and expiratory filters. A: 1 mg of budesonide nebulized continuously and delivered into the inspiratory limb. B: 1 mg of budesonide nebulized continuously and delivered between Y-piece and ETTC: Nebulized intermittently and delivered between Y-piece and ETT

Pelkonen AS, Nikander K, Turpeinen M. Pediatr Pulmonol 1997;24(4):282–286.

Jet nebulization of budesonide in neonatal ventilator circuitContinuous VS intermittent nebulization

intermittent

Inspired limb

Y piece- ETT

Y piece- ETT

Y piece- ETT

Y piece- ETT

Inspired limb

intermittentcontinuous

NebulizerNebulizerBest Aerosol deliveryBest Aerosol deliveryposition 30 position 30 cmscms from ETTfrom ETT

Position of the aerosol device in ventilator circuit

pMDIpMDIBest Aerosol deliveryBest Aerosol deliveryposition 15 position 15 cmscms from ETTfrom ETT

ประโยชนของ spacer

1. เปน reservoir ใหยา aerosol ลอยอยูกอนหายใจเขา

2. ลด velocity ของ particle ที่ออกจากกระบอกยา

ทําให particle ขนาดเล็กลง

3. ลดผลขางเคียงจาก cold Freon ที่ทําใหเกิด

apnea เมื่อพน MDI

ขนาด spacer

inspiratory volume หรอื tidal volume ผป.

โดยทั่วไปใชขนาด 140-750 มล.

เด็กเล็ก (tidal volume <50 มล.) ใชขนาด 150 มล.ได

Metered dose inhaler with spacer

inline MDI actuators for delivery of beta agonist/ corticosteroid with a mechanically-ventilated lung

Rau JL, Dunlevy CL, Hill RL. Respir Care 1998;43(9):705–712.

Metered dose inhaler with spacer Metered dose inhaler with spacer in ventilator circuitin ventilator circuit

Metered dose inhaler with spacer in ventilator circuit

Drug relatedFormulationDoseparticle sizetargeted siteduration of action

Factors that affect aerosol delivery and depositionFactors that affect aerosol delivery and deposition

Dhand R, Tobin MJ. Am J Respir Crit Care Med 1997;156(1):3–10.

Factors that influence aerosol delivery Factors that influence aerosol delivery

Aerosol particle size&

device

Ventilator circuit

Artificial airway

Ventilator setting

Factors that influence Factors that influence aerosol delivery aerosol delivery in mechanically in mechanically

ventilated patientsventilated patients

Mode: PC vs vCRR, TV Inspiratory flow rate I : E ratio

Position of device in ventilator circuit

Density of gasHumidification ETT Size

Aerosol particle sizeDevice related-NebulizerTypeGas flow rateCycling: Continuous or intermittent nebulizationDevice related-Metered-dose inhaler Adapter/spacer Timing of actuation

Aerosol delivery with Aerosol delivery with pMDIpMDI

ACE spacer connect to resuscitating bagACE spacer connect to resuscitating bag

Aerosol delivery with Aerosol delivery with pMDIpMDI

ACE spacer connect to ventilator circuitACE spacer connect to ventilator circuit

Aerosol delivery with Aerosol delivery with pMDIpMDI

Aerosol delivery with Aerosol delivery with pMDIpMDI

Aerosol delivery with Aerosol delivery with pMDIpMDI

adapter connect to ventilator circuitadapter connect to ventilator circuit

Aerosol delivery with Aerosol delivery with pMDIpMDI

adapter connect to ventilator circuitadapter connect to ventilator circuit