Optimization of aerosol deposition by pressure support in children with cystic fibrosis -: An experimental and clinical study

被引:72
作者
Fauroux, B
Itti, E
Pigeot, J
Isabey, D
Meignan, M
Ferry, G
Lofaso, F
Willemot, JM
Clément, A
Harf, A
机构
[1] Air Liquide Sante Int, Hop Enfants Armand Trousseau, Dept Pediat Pulmonol, F-75012 Paris, France
[2] Air Liquide Sante Int, Hop Enfants Armand Trousseau, Dept Nucl Med, F-75012 Paris, France
[3] Henri Mondor Hosp, Dept Nucl Med & Physiol, Funct Testing & Res Unit, INSERM,U492, Creteil, France
关键词
D O I
10.1164/ajrccm.162.6.2003069
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Nebulized aerosols are commonly used to deliver drugs into the lungs of patients with cystic fibrosis (CF). The aim of this study was to assess the effectiveness of pressure-support (PS) ventilation in increasing aerosol deposition within the lungs of children with CF. An in vitro study demonstrated the feasibility of coupling a breath-actuated nebulizer to a PS device. An in vivo study was done with 18 children (ages 6 to 21 yr) with clinically stable CF, each of whom underwent both a standard and a PS-driven ventilation scan (control session and PS session, respectively). In addition, a perfusion scan was used to determine lung outlines and to construct a geometric model for quantifying aerosol deposition by radioactivity counting in MBq. Homogeneity of nebulization was evaluated from the four first-order moments of aerosol distribution in the peripheral and central lung regions. The time-activity nebulization curve was linear in all patients, with higher slopes during the PS than during the control session (0.43 +/- 0.07 [mean SDI MBq/min and 0.32 +/- 0.23 MBq/min, respectively; p < 0.018). Quantitatively, aerosol deposition was about 30% greater after the PS session (4.4 +/- 2.7 MBq) than after the control session (3.4 +/- 2.1 MBq; p < 0.05). Similarly, deposition efficacy las a percentage of nebulizer output) was significantly better during the PS session than during the control session (15.3 +/- 8.3% versus 11.5 +/- 5.7%, p < 0.05). No differences in the regional deposition pattern or in homogeneity of uptake were observed. In conclusion, our data show that driving the delivery of a nebulized aerosol by noninvasive PS ventilation enhances total lung aerosol deposition without increasing particle impaction in the proximal airways.
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收藏
页码:2265 / 2271
页数:7
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