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The Use of an Inspiration-Synchronized Vibrating Mesh Nebulizer for Prolonged Inhalative Iloprost Administration in
Matthias Otto1, Yannik Kropp1, Evelyn Jäger2
1Department of Anaesthesiology and Critical Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68165 Mannheim, Germany.
Pharmaceutics
|August 26, 2023
Summary
Inspiration-synchronized nebulization with vibrating mesh nebulizers (VMN) offers prolonged iloprost delivery for acute respiratory distress syndrome (ARDS) patients. This method is most effective during volume-controlled ventilation, enhancing drug efficacy.
Area of Science:
- Respiratory Medicine
- Pharmacology
- Biomedical Engineering
Background:
- Mechanically ventilated patients with ARDS often receive aerosolized iloprost.
- Prostacyclin's short half-life necessitates prolonged administration for improved efficacy, posing technical challenges.
- Inspiration-synchronized vibrating mesh nebulizers (VMNsyn) offer potential for high drug deposition and prolonged nebulization.
Purpose of the Study:
- To compare prolonged vs. bolus iloprost nebulization using continuous (VMNcont) and synchronized (VMNsyn) vibrating mesh nebulizers.
- To investigate the impact of different mechanical ventilation modes on synchronized nebulization.
- To evaluate iloprost deposition rates and nebulization times in an in vitro model.
Main Methods:
- Comparison of VMNsyn and VMNcont in an in vitro model of mechanically ventilated adults.
- Testing under volume-controlled (VC-CMV) and pressure-controlled (PC-CMV) ventilation modes.
- Measurement of iloprost deposition rate and nebulization time.
Main Results:
- VMNsyn deposition rate was comparable to VMNcont during VC-CMV but 10.9% lower during PC-CMV.
- VMNsyn showed significantly lower aerosol output than VMNcont in both modes.
- Nebulization time was 7.5x longer with VMNsyn during VC-CMV and 4.2x longer during PC-CMV.
Conclusions:
- Inspiration-synchronized nebulization during VC-CMV is suitable for prolonged inhalative iloprost administration.
- VMNsyn offers a viable method for extended drug delivery in mechanically ventilated ARDS patients.
- Ventilation mode significantly impacts the efficiency of synchronized nebulization.
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