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In Vitro Performance of an Investigational Vibrating-Membrane Nebulizer with Surfactant under Simulated, Non-Invasive Neonatal Ventilation Conditions: Influence of Continuous Positive Airway Pressure Interface and Nebulizer Positioning on the Lung Dose

Non-invasive delivery of nebulized surfactant has been a long-pursued goal in neonatology. Our aim was to evaluate the performance of an investigational vibrating-membrane nebulizer in a realistic non-invasive neonatal ventilation circuit with different configurations. Surfactant (aerosols were gene...

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Autores principales: Bianco, Federico, Pasini, Elena, Nutini, Marcello, Murgia, Xabier, Stoeckl, Carolin, Schlun, Martin, Hetzer, Uwe, Bonelli, Sauro, Lombardini, Marta, Milesi, Ilaria, Pertile, Marisa, Minocchieri, Stefan, Salomone, Fabrizio, Bucholski, Albert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151046/
https://www.ncbi.nlm.nih.gov/pubmed/32178276
http://dx.doi.org/10.3390/pharmaceutics12030257
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author Bianco, Federico
Pasini, Elena
Nutini, Marcello
Murgia, Xabier
Stoeckl, Carolin
Schlun, Martin
Hetzer, Uwe
Bonelli, Sauro
Lombardini, Marta
Milesi, Ilaria
Pertile, Marisa
Minocchieri, Stefan
Salomone, Fabrizio
Bucholski, Albert
author_facet Bianco, Federico
Pasini, Elena
Nutini, Marcello
Murgia, Xabier
Stoeckl, Carolin
Schlun, Martin
Hetzer, Uwe
Bonelli, Sauro
Lombardini, Marta
Milesi, Ilaria
Pertile, Marisa
Minocchieri, Stefan
Salomone, Fabrizio
Bucholski, Albert
author_sort Bianco, Federico
collection PubMed
description Non-invasive delivery of nebulized surfactant has been a long-pursued goal in neonatology. Our aim was to evaluate the performance of an investigational vibrating-membrane nebulizer in a realistic non-invasive neonatal ventilation circuit with different configurations. Surfactant (aerosols were generated with a nebulizer in a set-up composed of a continuous positive airway pressure (CPAP) generator with a humidifier, a cast of the upper airway of a preterm infant (PrINT), and a breath simulator with a neonatal breathing pattern. The lung dose (LD), defined as the amount of surfactant collected in a filter placed at the distal end of the PrINT cast, was determined after placing the nebulizer at different locations of the circuit and using either infant nasal mask or nasal prongs as CPAP interfaces. The LD after delivering a range of nominal surfactant doses (100–600 mg/kg) was also investigated. Surfactant aerosol particle size distribution was determined by laser diffraction. Irrespective of the CPAP interface used, about 14% of the nominal dose (200 mg/kg) reached the LD filter. However, placing the nebulizer between the Y-piece and the CPAP interface significantly increased the LD compared with placing it 7 cm before the Y-piece, in the inspiratory limb. (14% ± 2.8 vs. 2.3% ± 0.8, nominal dose of 200 mg/kg). The customized eFlow Neos showed a constant aerosol generation rate and a mass median diameter of 2.7 μm after delivering high surfactant doses (600 mg/kg). The customized eFlow Neos nebulizer showed a constant performance even after nebulizing high doses of undiluted surfactant. Placing the nebulizer between the Y-piece and the CPAP interface achieves the highest LD under non-invasive ventilation conditions.
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spelling pubmed-71510462020-04-20 In Vitro Performance of an Investigational Vibrating-Membrane Nebulizer with Surfactant under Simulated, Non-Invasive Neonatal Ventilation Conditions: Influence of Continuous Positive Airway Pressure Interface and Nebulizer Positioning on the Lung Dose Bianco, Federico Pasini, Elena Nutini, Marcello Murgia, Xabier Stoeckl, Carolin Schlun, Martin Hetzer, Uwe Bonelli, Sauro Lombardini, Marta Milesi, Ilaria Pertile, Marisa Minocchieri, Stefan Salomone, Fabrizio Bucholski, Albert Pharmaceutics Article Non-invasive delivery of nebulized surfactant has been a long-pursued goal in neonatology. Our aim was to evaluate the performance of an investigational vibrating-membrane nebulizer in a realistic non-invasive neonatal ventilation circuit with different configurations. Surfactant (aerosols were generated with a nebulizer in a set-up composed of a continuous positive airway pressure (CPAP) generator with a humidifier, a cast of the upper airway of a preterm infant (PrINT), and a breath simulator with a neonatal breathing pattern. The lung dose (LD), defined as the amount of surfactant collected in a filter placed at the distal end of the PrINT cast, was determined after placing the nebulizer at different locations of the circuit and using either infant nasal mask or nasal prongs as CPAP interfaces. The LD after delivering a range of nominal surfactant doses (100–600 mg/kg) was also investigated. Surfactant aerosol particle size distribution was determined by laser diffraction. Irrespective of the CPAP interface used, about 14% of the nominal dose (200 mg/kg) reached the LD filter. However, placing the nebulizer between the Y-piece and the CPAP interface significantly increased the LD compared with placing it 7 cm before the Y-piece, in the inspiratory limb. (14% ± 2.8 vs. 2.3% ± 0.8, nominal dose of 200 mg/kg). The customized eFlow Neos showed a constant aerosol generation rate and a mass median diameter of 2.7 μm after delivering high surfactant doses (600 mg/kg). The customized eFlow Neos nebulizer showed a constant performance even after nebulizing high doses of undiluted surfactant. Placing the nebulizer between the Y-piece and the CPAP interface achieves the highest LD under non-invasive ventilation conditions. MDPI 2020-03-12 /pmc/articles/PMC7151046/ /pubmed/32178276 http://dx.doi.org/10.3390/pharmaceutics12030257 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Bianco, Federico
Pasini, Elena
Nutini, Marcello
Murgia, Xabier
Stoeckl, Carolin
Schlun, Martin
Hetzer, Uwe
Bonelli, Sauro
Lombardini, Marta
Milesi, Ilaria
Pertile, Marisa
Minocchieri, Stefan
Salomone, Fabrizio
Bucholski, Albert
In Vitro Performance of an Investigational Vibrating-Membrane Nebulizer with Surfactant under Simulated, Non-Invasive Neonatal Ventilation Conditions: Influence of Continuous Positive Airway Pressure Interface and Nebulizer Positioning on the Lung Dose
title In Vitro Performance of an Investigational Vibrating-Membrane Nebulizer with Surfactant under Simulated, Non-Invasive Neonatal Ventilation Conditions: Influence of Continuous Positive Airway Pressure Interface and Nebulizer Positioning on the Lung Dose
title_full In Vitro Performance of an Investigational Vibrating-Membrane Nebulizer with Surfactant under Simulated, Non-Invasive Neonatal Ventilation Conditions: Influence of Continuous Positive Airway Pressure Interface and Nebulizer Positioning on the Lung Dose
title_fullStr In Vitro Performance of an Investigational Vibrating-Membrane Nebulizer with Surfactant under Simulated, Non-Invasive Neonatal Ventilation Conditions: Influence of Continuous Positive Airway Pressure Interface and Nebulizer Positioning on the Lung Dose
title_full_unstemmed In Vitro Performance of an Investigational Vibrating-Membrane Nebulizer with Surfactant under Simulated, Non-Invasive Neonatal Ventilation Conditions: Influence of Continuous Positive Airway Pressure Interface and Nebulizer Positioning on the Lung Dose
title_short In Vitro Performance of an Investigational Vibrating-Membrane Nebulizer with Surfactant under Simulated, Non-Invasive Neonatal Ventilation Conditions: Influence of Continuous Positive Airway Pressure Interface and Nebulizer Positioning on the Lung Dose
title_sort in vitro performance of an investigational vibrating-membrane nebulizer with surfactant under simulated, non-invasive neonatal ventilation conditions: influence of continuous positive airway pressure interface and nebulizer positioning on the lung dose
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151046/
https://www.ncbi.nlm.nih.gov/pubmed/32178276
http://dx.doi.org/10.3390/pharmaceutics12030257
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