Multidrug Aerosol Delivery During Mechanical Ventilation

Area of Science:

• Critical Care Medicine
• Respiratory Therapy
• Aerosol Science

Background:

• Pulmonary vasodilators are often administered off-label to intubated patients via continuous nebulization.
• Interruption of vasodilator therapy can occur when additional aerosolized medications (e.g., bronchodilators, antibiotics) are required.
• Existing aerosol systems may not support simultaneous delivery of multiple therapies without compromising treatment continuity.

Purpose of the Study:

• To assess the feasibility and performance of aerosol systems designed for simultaneous delivery of two aerosols via continuous nebulization and bolus injection.
• To evaluate if these systems can operate without interruption or disconnection of the breathing circuit.
• To compare the inhaled mass delivery characteristics of a dual-port breath-enhanced jet nebulizer (BEJN) and stacked vibrating mesh nebulizers (VMNs).

Main Methods:

• One i-AIRE dual-port breath-enhanced jet nebulizer (BEJN) and two Aerogen® Solo vibrating mesh nebulizers (VMNs) were tested.
• VMNs were configured in a stacked arrangement for continuous infusion and bolus delivery.
• Radiolabeled saline was used to quantify inhaled mass (% of initial syringe activity) under different breathing patterns and delivery modes over a 4-hour infusion period.

Main Results:

• Continuous infusion of aerosolized medication was linear and predictable for both BEJN and VMN systems.
• The BEJN functioned without incident throughout the study.
• VMN systems experienced spontaneous interruptions in both continuous (38%) and bolus (19%) delivery modes, which were resolved by tapping; bolus delivery yielded higher inhaled mass percentages for VMN compared to BEJN.

Conclusions:

• Simultaneous continuous and bolus aerosol nebulization without circuit disconnection is achievable with both jet and mesh nebulizer technologies.
• The BEJN demonstrated reliable performance, while VMNs may require monitoring due to potential spontaneous interruptions.
• These findings support the development of integrated aerosol delivery systems for complex therapeutic regimens in critically ill patients.