Islam O F Moustafa1, Mohammed R A-A Ali2, Moataz Al Hallag3, Hoda Rabea4, James B Fink5, Patricia Dailey6, Mohamed E A Abdelrahim7. 1. Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt; Clinical Pharmacist Department, Saudi German Hospital SGH, Cairo, Egypt. Electronic address: islam_mwm@yahoo.com. 2. Pharmacology and Toxicology Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt. Electronic address: mohammedragab20141@gmail.com. 3. Critical Care Medicine, Critical Care, Faculty of Medicine, Cairo University, Egypt. Electronic address: moatazaf@yahoo.com. 4. Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt. Electronic address: hoda_cp@yahoo.com. 5. Division Allied Health, Georgia State University, Atlanta, GA, USA. Electronic address: fink.jim@gmail.com. 6. Medical Affairs/Clinical, Medical Science Liaison, Aerogen, Ltd., Galway, Ireland. Electronic address: patriciaanndailey@gmail.com. 7. Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt; Clinical Pharmacy Department, Faculty of Pharmacy, Ahram Canadian University, Giza, Egypt. Electronic address: mohamedemam9@yahoo.com.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
RCT Entities:
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Bhavya Vishwa; Afrasim Moin; D V Gowda; Syed M D Rizvi; Wael A H Hegazy; Amr S Abu Lila; El-Sayed Khafagy; Ahmed N Allam Journal: Pharmaceutics Date: 2021-01-08 Impact factor: 6.321
Authors: Shaoqing Chai; Yan Li; Xuemei Li; Jie Tan; Mohamed E A Abdelrahim; Xiaoxiao Xu Journal: Int J Clin Pract Date: 2021-08-01 Impact factor: 3.149