Nebulizer Article
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Questions and Answers

Which variables influence the effectiveness of aerosol drug delivery during mechanical ventilation?

  • Patient's age and gender
  • Nebulizer type and position on the ventilator circuit (correct)
  • Ventilator brand and model
  • Humidity level in the patient's room

    • What was nebulized in the study to determine the influence of nebulizer position and bias flow?

  • Saline solution
  • Albuterol sulfate (2.5 mg) (correct)
  • Corticosteroids
  • Sterile water

    • Where was the jet nebulizer placed in the second nebulizer position?

  • Positioned at an inlet to the humidifier
  • Before the heated humidifier with 15 cm of large-bore tubing (correct)
  • 15 cm from the Y-piece adapter
  • Directly attached to the Y-piece

    • What was used as simulated models in the study?

    <p>Simulated pediatric and adult lung models</p> Signup and view all the answers

    Which factors had not been established for different age populations according to the article?

    <p>Impact of nebulizer type, position, and bias flow on aerosol drug delivery</p> Signup and view all the answers

    What is the main objective of this study?

    <p>To evaluate the influence of nebulizer position and bias flow on aerosol drug delivery</p> Signup and view all the answers

    What is the effect of nebulizer placement on drug delivery according to the study?

    <p>Nebulizer placement prior to the humidifier increased drug delivery with both the jet nebulizer and the vibrating-mesh nebulizer, with a greater increase with the jet nebulizer.</p> Signup and view all the answers

    Which type of nebulizer provided higher efficiency when placed proximal to the ventilator during simulated adult mechanical ventilation, according to the study?

    <p>Jet nebulizers</p> Signup and view all the answers

    What factor greatly influences aerosol drug delivery in mechanically ventilated adults, as reported in the study?

    <p>Peak inspiratory flow</p> Signup and view all the answers

    What impact did higher bias flow have on drug delivery during simulated mechanical ventilation in both lung models?

    <p>Higher bias flow reduced drug delivery.</p> Signup and view all the answers

    What was the inner-diameter of the endotracheal tubes used for the adult and pediatric lung models, respectively?

    <p>8-mm for adult and 5-mm for pediatric lung models</p> Signup and view all the answers

    What method was used to analyze albuterol sulfate in the study?

    <p>Spectrophotometry</p> Signup and view all the answers

    What is a key factor that influences aerosol drug deposition in intubated and mechanically ventilated patients, according to the study?

    <p>Physical properties of the drug</p> Signup and view all the answers

    Which factor differentiates aerosol delivery efficiency according to previous studies mentioned in the text?

    <p>Residual drug volume</p> Signup and view all the answers

    What did Hughes and Saez find regarding nebulizer placement influencing aerosol drug delivery during mechanical ventilation?

    <p>Moving the nebulizer back to the manifold position doubled the aerosol drug delivery during mechanical ventilation, compared to nebulizer placement at the Y-piece.</p> Signup and view all the answers

    What did recent studies compare regarding aerosol drug delivery efficiency during simulated adult mechanical ventilation?

    <p>They compared efficiency across different types of nebulizers and various positions.</p> Signup and view all the answers

    In the study, which type of nebulizer consistently delivered more drug than the other?

    <p>Vibrating-mesh nebulizer</p> Signup and view all the answers

    What was the impact of bias flow on aerosol delivery according to the findings of the study?

    <p>Decrease in drug delivery with increasing bias flow</p> Signup and view all the answers

    What was the difference in aerosol delivery between position 1 and position 2 with the pediatric model using a jet nebulizer?

    <p>Similar delivery at both positions</p> Signup and view all the answers

    Why did the vibrating-mesh nebulizer deliver less drug when positioned at the ventilator in a previous study?

    <p>Greater internal volume of the circuit and humidifier chamber</p> Signup and view all the answers

    What was the effect of bias flow on aerosol delivery with the vibrating-mesh nebulizer in the adult circuit?

    <p>Increased drug delivery with increasing bias flow</p> Signup and view all the answers

    What was the impact of bias flow on aerosol delivery with the jet nebulizer in the adult circuit?

    <p>Decrease in drug delivery with increasing bias flow</p> Signup and view all the answers

    What was the difference in aerosol delivery between position 2 and position 1 with the adult model using a vibrating-mesh nebulizer?

    <p>Increased delivery at position 2</p> Signup and view all the answers

    What was the impact of bias flow on aerosol delivery with the jet nebulizer in the pediatric circuit?

    <p>No impact on drug delivery</p> Signup and view all the answers

    What was the difference in aerosol delivery between the adult and pediatric models at position 2 using a jet nebulizer?

    <p>Similar delivery in both models</p> Signup and view all the answers

    What was found to be consistent across both adult and pediatric models according to the study findings?

    <p>Similar aerosol delivery with both nebulizer types</p> Signup and view all the answers

    What was speculated as a possible reason for reduced drug delivery when a vibrating-mesh nebulizer was positioned at the ventilator?

    <p>Lack of aerosol reservoir effect</p> Signup and view all the answers

    What is one of the findings of greatest clinical relevance according to the study?

    <p>Minor impact on efficacy or patient safety due to bias flow</p> Signup and view all the answers

    What can reduce aerosol delivery by up to 50% compared to ventilation under ambient conditions with anhydrous gas mixtures?

    <p>Heating and humidifying the circuit gas</p> Signup and view all the answers

    What is the purpose of continuous bias flow through the ventilator circuit?

    <p>To reduce patient work of breathing</p> Signup and view all the answers

    Which factor reduces aerosol delivery efficiency in infants and small children compared to adults?

    <p>Differences in anatomical proportion</p> Signup and view all the answers

    What did the study aim to determine the influence of during simulated mechanical ventilation of pediatric and adult patients?

    <p>Bias flow, nebulizer type, and position on aerosol drug delivery</p> Signup and view all the answers

    What is the purpose of maintaining the natural curve of the endotracheal tube (ETT) during ventilation?

    <p>To prevent condensate or liquid medication from reaching the filter media</p> Signup and view all the answers

    Which nebulizer uses pressurized gas to form a jet passing over a capillary tube that draws liquid formulation into the jet stream to produce aerosol?

    <p>Misty Finity (Cardinal Health, Dublin, Ohio)</p> Signup and view all the answers

    Which device uses electricity to vibrate an aperture plate at 128 kHz to produce aerosol?

    <p>AeroNeb Solo (Aerogen, Mountain View, California)</p> Signup and view all the answers

    What was the compliance of the test lung set to simulate a mechanically ventilated adult or small pediatric patient?

    <p>$0.1 L/cm H2O$</p> Signup and view all the answers

    What is the main advantage of the vibrating-mesh nebulizer over the jet nebulizer?

    <p>Higher drug delivery efficiency</p> Signup and view all the answers

    In the study, how did the vibrating-mesh nebulizer compare to the jet nebulizer in terms of aerosol delivery?

    <p>Vibrating-mesh nebulizer delivered 2–4 times more aerosol than the jet nebulizer</p> Signup and view all the answers

    At which position in the ventilator circuit was the vibrating-mesh nebulizer more efficient?

    <p>Position 2 for both adult and pediatric models</p> Signup and view all the answers

    How did the bias flow affect aerosol drug delivery with the jet nebulizer?

    <p>Higher bias flow decreased aerosol drug delivery</p> Signup and view all the answers

    What was used to determine the albuterol concentration in the experiments?

    <p>Spectrophotometry</p> Signup and view all the answers

    What was the residual drug volume for the vibrating-mesh nebulizer?

    <p>0.1–0.3 mL</p> Signup and view all the answers

    How many times was each experiment run in the study?

    <p>3</p> Signup and view all the answers

    What was used to collect the inhaled mass of albuterol sulfate?

    <p>Absolute filter at the distal tip of the ETT</p> Signup and view all the answers

    What is the potential benefit of placing the nebulizer proximal to the ventilator?

    <p>Reducing the risk of bacterial contamination in the inspiratory limb</p> Signup and view all the answers

    What raises a concern with the heating of medication in the heated humidifier reservoir?

    <p>Formation of hazardous vapors at ⱖ 70°C</p> Signup and view all the answers

    What is a limitation of the study's results?

    <p>Deposited dose reflecting the amount of inhaled aerosol exhaled in vivo</p> Signup and view all the answers

    What is a factor that greatly influences aerosol drug delivery during mechanical ventilation, according to the study?

    <p>The type of nebulizer used</p> Signup and view all the answers

    What did Moraine and co-workers find regarding ipratropium in mechanically ventilated adult patients after 500 ␮g via nebulizer?

    <p>No difference in ipratropium in urine based on nebulizer placement</p> Signup and view all the answers

    What does reducing the risk of nebulizers with lower residual volume depositing greater volumes of liquid in the inspiratory limb help prevent?

    <p>Occlusion of the airway by condensate</p> Signup and view all the answers

    What is a potential benefit of isolating the aerosol generator from retrograde contamination?

    <p>Reduction in liquid condensate load in the circuit</p> Signup and view all the answers

    What does higher bias flow decrease in models of adult and pediatric mechanical ventilation?

    <p>Aerosol drug delivery from jet nebulizers</p> Signup and view all the answers

    What is a potential concern regarding drugs heated at ⱖ 70°C for extended periods?

    <p>Reduced stability and potential formation of hazardous vapors</p> Signup and view all the answers

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