Pulmonary Drug Delivery Following Continuous Vibrating Mesh Nebulization and Inspiratory Synchronized Vibrating Mesh Nebulization During Noninvasive Ventilation in Healthy Volunteers.

Michotte, Jean-Bernard;Staderini, Enrico;Aubriot, Anne-Sophie;Jossen, Emilie;Reychler, Gregory;et.al.
(2018) Journal of Aerosol Medicine and Pulmonary Drug Delivery — Vol. 31, p. 33-41 (2018)

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Authors
  • Michotte, Jean-Bernard
    Author
  • Staderini, Enrico
    Author
  • Aubriot, Anne-SophieUCLouvain
    Author
  • Jossen, Emilie
    Author
  • Dugernier, JonathanUCLouvain
    Author
  • Liistro, GiuseppeUCLouvain
    Author
  • Reychler, Gregoryorcid-logoUCLouvain
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Abstract
BACKGROUND: A breath-synchronized nebulization option that could potentially improve drug delivery during noninvasive positive pressure ventilation (NIPPV) is currently not available on single-limb circuit bilevel ventilators. The aim of this study was to compare urinary excretion of amikacin following aerosol delivery with a vibrating mesh nebulizer coupled to a single-limb circuit bilevel ventilator, using conventional continuous (Conti-Neb) and experimental inspiratory synchronized (Inspi-Neb) nebulization modes. MATERIALS AND METHODS: A crossover clinical trial involving 6 noninvasive ventilated healthy volunteers (mean age of 32.3 ± 9.5 y) randomly assigned to both vibrating mesh nebulization modes was conducted: Inspi-Neb delivered aerosol during only the whole inspiratory phase, whereas Conti-Neb delivered aerosol continuously. All subjects inhaled amikacin solution (500 mg/4 mL) during NIPPV using a single-limb bilevel ventilator (inspiratory positive airway pressure: 12 cm H2O, and expiratory positive airway pressure: 5 cm H2O). Pulmonary drug delivery of amikacin following both nebulization modes was compared by urinary excretion of drug for 24 hours post-inhalation. RESULTS: The total daily amount of amikacin excreted in the urine was significantly higher with Inspi-Neb (median: 44.72 mg; interquartile range [IQR]: 40.50-65.13) than with Conti-Neb (median: 40.07 mg; IQR: 31.00-43.73), (p = 0.02). The elimination rate constant of amikacin (indirect measure of the depth of drug penetration into the lungs) was significantly higher with Inspi-Neb (median: 0.137; IQR: 0.113-0.146) than with Conti-Neb (median: 0.116; IQR: 0.105-0.130), (p = 0.02). However, the mean pulmonary drug delivery rate, expressed as the ratio between total daily urinary amount of amikacin and nebulization time, was significantly higher with Conti-Neb (2.03 mg/min) than with Inspi-Neb (1.09 mg/min) (p < 0.01). CONCLUSIONS: During NIPPV with a single-limb circuit bilevel ventilator, the use of inspiratory synchronized vibrating mesh nebulization may improve pulmonary drug delivery compared with conventional continuous vibrating mesh nebulization. KEYWORDS: aerosol delivery; amikacin; bilevel ventilator; breath-synchronized nebulizer; healthy volunteers; nebulization; nebulization mode; noninvasive positive pressure ventilation; pulmonary drug delivery; single-limb circuit ventilator; vibrating mesh nebulizer
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Michotte, J.-B., Staderini, E., Aubriot, A.-S., Jossen, E., Dugernier, J., Liistro, G., & Reychler, G. (2018). Pulmonary Drug Delivery Following Continuous Vibrating Mesh Nebulization and Inspiratory Synchronized Vibrating Mesh Nebulization During Noninvasive Ventilation in Healthy Volunteers. Journal of Aerosol Medicine and Pulmonary Drug Delivery, 31, 33-41. https://doi.org/10.1089/jamp.2016.1339 (Original work published 2018)