Albuterol delivery by metered-dose inhaler in a mechanically ventilated pediatric lung model

Objectives: To assess albuterol delivery by metered-dose inhaler in a mechanically ventilated pediatric lung model and to determine the influence of the following variables on albuterol delivery: endotracheal tube diameter; type of spacer; humidification; and pulmonary mechanics. Design: Prospective, in vitro, laboratory study. Setting: Research laboratory. Interventions: A model, consisting of a volume-cycled ventilator, pediatric breathing circuit, 4.0- or 6.0-mm endotracheal tube, and lung simulator, was assembled, Ventilator settings were: tidal volume 250 mL; FlO(2) 0.5; inspiration/expiration ratio 1:3; respiratory rate 25 breaths/min; positive end expiratory pressure 3 cm H2O; temperature 35 degrees C; and a decelerating flow pattern, using dry and humidified air, Lung simulator compliance and resistance values were consistent with those values reported for healthy children (20 mL/cm H2O and 40 cm H2O/L/sec) and children with pulmonary disease (10 mL/cm H2O and 60 cm H2O/L/sec), Pulmonary mechanics were verified with a pulmonary function diagnostic system, Ten metered-dose inhaler canisters were used to administer 2000 mu g of albuterol, using either a collapsible or a rigid spacer, A circuit filter placed immediately proximal to the test lung collected drug exiting the endotracheal tube, The filter was rinsed with water and albuterol concentrations were determined by high-performance liquid chromatography, Each variable was tested in triplicate. Measurements and Main Results: Albuterol delivery was significantly (p less than or equal to .05) greater for the 6.0-mm endotracheal tube, rigid spacer, dry air, and pulmonary disease mechanics by multifactor analysis of variance, Drug delivery in humidified air with pulmonary disease mechanics using the rigid chamber was 2.5 +/- 0.27% and 6.3 +/- 0.99% for the 4.0- and 6.0-mm endotracheal tubes, respectively. Conclusions: These in vitro results suggest that pulmonary disease mechanics and a 6.0-mm endotracheal tube improve albuterol delivery, Future clinical investigations in intubated pediatric patients with pulmonary disease are needed to address the clinical significance of these results.