AEROGEN – The art of nebulization

VA Palo Alto Hospital

What is aerogen?

• High efficiency vibrating mesh aerosol drug delivery system

• Inline or stand alone

Aerogen is the company

When do we use ithere at the VA?

• Unit dose medication – 1. Mech. Ventilator (in-

line) 2. V60• Continuous aerosol -

Flolan• Transport – ambu bag

How does it benefits us?

• Contamination Risk• Drug deposition- high quality• No additional flow to system – does not trigger vent alarms• Cost Reduction – monthly• 22% Decrease in LOS in ICU• Improve staff satisfaction• All medications (including abx, mucomyst)Note: rinse with couple of drops of NaCl- clears the pores

Comparison of Aerogen to MDI

Economical drug delivery, savings verses MDI

Easy to operatePropellant freeDelivers more drug per dose

•High cost per canister•Technique dependent – timed with inspiration•HFA propellants•Delivers less drug per dose

Aerogen MDI

comparison of Aerogen to standard nebs

9 times more drug deposition than SVN

No flow added to the circuitReduction in time to deliver meds – 7.5mg continuous neb cut from 1-hour to 8-minutes

Faster patient response

Drug waste – residual volume 0.8 -1.2ml

Adds flow requiring changes in vent parameters

Re nebulizes condensateContamination risks

Aerogen Standard nebulizer

Efficiency Studies

Set Up

• V500• LTV

Drager XL is retiring!!

Filter! Filter!

Set up on NIV(Mask)

V60

Position #2

Not here!

Aerogen-V60 Set up on patient

Flolan set up-Before-

Flolan Set up -after-

Dual Pump or syringe?

Trouble shooting

RIGHT

WRONG

Check:•Connections•Power Source•Position 1.Adaptor2.Aerogen

Transport

During Flolan transport

Future:Continuous Neb in ED and HFNC

Why in ED?

Policy and procedure

• Please see VA policy procedure manual book.• Respiratory Department

• Also check out Aerogen handbook for more detailed information!

How to use it?(Set up)

DEMO TIME!

The END

1.) Clinical White Paper document “Aerogen, Pioneering Aerosol Drug Delivery”, Retrieved (2016, October 31) from www.aerogen.com Dangan, Galway Ireland, Aerogen Ltd.2.) Power Point presentation “The Art of Nebulization” by: Peter Kahane CRT, RCP, AE-C, Retrieved (2016, October 30)

3.) PubMed Article, from Nih.gov “Performance Comparisons of Jet and Mesh Nebulizers Using Different Interfaces in Simulated Spontaneously Breathing Adults and Children”, retrived (2016, October 31) from https://www.ncbi.nlm.nih.gov/pubmed/25493535

Questions?

References:

Special thanks to: Byron Shipp for the policy and procedures.