The Use of an Inspiration-Synchronized Vibrating Mesh Nebulizer for Prolonged Inhalative Iloprost Administration in Mechanically Ventilated Patients—An In Vitro Model
Mechanically ventilated patients suffering from acute respiratory distress syndrome (ARDS) frequently receive aerosolized iloprost. Because of prostacyclin’s short half-life, prolonged inhalative administration might improve its clinical efficacy. But, this is technically challenging. A solution mig...
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| Format: | Article |
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MDPI AG
2023-08-01
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| Series: | Pharmaceutics |
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| Online Access: | https://www.mdpi.com/1999-4923/15/8/2080 |
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| author | Matthias Otto Yannik Kropp Evelyn Jäger Michael Neumaier Manfred Thiel Michael Quintel Charalambos Tsagogiorgas |
| author_facet | Matthias Otto Yannik Kropp Evelyn Jäger Michael Neumaier Manfred Thiel Michael Quintel Charalambos Tsagogiorgas |
| author_sort | Matthias Otto |
| collection | DOAJ |
| description | Mechanically ventilated patients suffering from acute respiratory distress syndrome (ARDS) frequently receive aerosolized iloprost. Because of prostacyclin’s short half-life, prolonged inhalative administration might improve its clinical efficacy. But, this is technically challenging. A solution might be the use of inspiration-synchronized vibrating mesh nebulizers (VMN<sub>syn</sub>), which achieve high drug deposition rates while showing prolonged nebulization times. However, there are no data comparing prolonged to bolus iloprost nebulization using a continuous vibrating mesh nebulizer (VMN<sub>cont</sub>) and investigating the effects of different ventilation modes on inspiration-synchronized nebulization. Therefore, in an in vitro model of mechanically ventilated adults, a VMN<sub>syn</sub> and a VMN<sub>cont</sub> were compared in volume-controlled (VC-CMV) and pressure-controlled continuous mandatory ventilation (PC-CMV) regarding iloprost deposition rate and nebulization time. During VC-CMV, the deposition rate of the VMN<sub>syn</sub> was comparable to the rate obtained with the VMN<sub>cont</sub>, but 10.9% lower during PC-CMV. The aerosol output of the VMN<sub>syn</sub> during both ventilation modes was significantly lower compared to the VMN<sub>cont</sub>, leading to a 7.5 times longer nebulization time during VC-CMV and only to a 4.2 times longer nebulization time during PC-CMV. Inspiration-synchronized nebulization during VC-CMV mode therefore seems to be the most suitable for prolonged inhalative iloprost administration in mechanically ventilated patients. |
| first_indexed | 2024-03-10T23:39:11Z |
| format | Article |
| id | doaj.art-0090a898fc064002b5375be9eabd8afc |
| institution | Directory Open Access Journal |
| issn | 1999-4923 |
| language | English |
| last_indexed | 2024-03-10T23:39:11Z |
| publishDate | 2023-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Pharmaceutics |
| spelling | doaj.art-0090a898fc064002b5375be9eabd8afc2023-11-19T02:36:29ZengMDPI AGPharmaceutics1999-49232023-08-01158208010.3390/pharmaceutics15082080The Use of an Inspiration-Synchronized Vibrating Mesh Nebulizer for Prolonged Inhalative Iloprost Administration in Mechanically Ventilated Patients—An In Vitro ModelMatthias Otto0Yannik Kropp1Evelyn Jäger2Michael Neumaier3Manfred Thiel4Michael Quintel5Charalambos Tsagogiorgas6Department 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, GermanyDepartment 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, GermanyInstitute for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, GermanyInstitute for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, GermanyDepartment 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, GermanyDepartment of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, GermanyDepartment 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, GermanyMechanically ventilated patients suffering from acute respiratory distress syndrome (ARDS) frequently receive aerosolized iloprost. Because of prostacyclin’s short half-life, prolonged inhalative administration might improve its clinical efficacy. But, this is technically challenging. A solution might be the use of inspiration-synchronized vibrating mesh nebulizers (VMN<sub>syn</sub>), which achieve high drug deposition rates while showing prolonged nebulization times. However, there are no data comparing prolonged to bolus iloprost nebulization using a continuous vibrating mesh nebulizer (VMN<sub>cont</sub>) and investigating the effects of different ventilation modes on inspiration-synchronized nebulization. Therefore, in an in vitro model of mechanically ventilated adults, a VMN<sub>syn</sub> and a VMN<sub>cont</sub> were compared in volume-controlled (VC-CMV) and pressure-controlled continuous mandatory ventilation (PC-CMV) regarding iloprost deposition rate and nebulization time. During VC-CMV, the deposition rate of the VMN<sub>syn</sub> was comparable to the rate obtained with the VMN<sub>cont</sub>, but 10.9% lower during PC-CMV. The aerosol output of the VMN<sub>syn</sub> during both ventilation modes was significantly lower compared to the VMN<sub>cont</sub>, leading to a 7.5 times longer nebulization time during VC-CMV and only to a 4.2 times longer nebulization time during PC-CMV. Inspiration-synchronized nebulization during VC-CMV mode therefore seems to be the most suitable for prolonged inhalative iloprost administration in mechanically ventilated patients.https://www.mdpi.com/1999-4923/15/8/2080nebulizersaerosol drug therapyiloprostvibrating mesh nebulizeraerosol depositionmechanical ventilation |
| spellingShingle | Matthias Otto Yannik Kropp Evelyn Jäger Michael Neumaier Manfred Thiel Michael Quintel Charalambos Tsagogiorgas The Use of an Inspiration-Synchronized Vibrating Mesh Nebulizer for Prolonged Inhalative Iloprost Administration in Mechanically Ventilated Patients—An In Vitro Model Pharmaceutics nebulizers aerosol drug therapy iloprost vibrating mesh nebulizer aerosol deposition mechanical ventilation |
| title | The Use of an Inspiration-Synchronized Vibrating Mesh Nebulizer for Prolonged Inhalative Iloprost Administration in Mechanically Ventilated Patients—An In Vitro Model |
| title_full | The Use of an Inspiration-Synchronized Vibrating Mesh Nebulizer for Prolonged Inhalative Iloprost Administration in Mechanically Ventilated Patients—An In Vitro Model |
| title_fullStr | The Use of an Inspiration-Synchronized Vibrating Mesh Nebulizer for Prolonged Inhalative Iloprost Administration in Mechanically Ventilated Patients—An In Vitro Model |
| title_full_unstemmed | The Use of an Inspiration-Synchronized Vibrating Mesh Nebulizer for Prolonged Inhalative Iloprost Administration in Mechanically Ventilated Patients—An In Vitro Model |
| title_short | The Use of an Inspiration-Synchronized Vibrating Mesh Nebulizer for Prolonged Inhalative Iloprost Administration in Mechanically Ventilated Patients—An In Vitro Model |
| title_sort | use of an inspiration synchronized vibrating mesh nebulizer for prolonged inhalative iloprost administration in mechanically ventilated patients an in vitro model |
| topic | nebulizers aerosol drug therapy iloprost vibrating mesh nebulizer aerosol deposition mechanical ventilation |
| url | https://www.mdpi.com/1999-4923/15/8/2080 |
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