Aerosol delivery with two ventilation modes during mechanical ventilation: a randomized study

Jonathan Dugernier, Gregory Reychler, Xavier Wittebole, Jean Roeseler, Virginie Depoortere, Thierry Sottiaux, Jean-Bernard Michotte, Rita Vanbever, Thierry Dugernier, Pierre Goffette, Marie-Agnes Docquier, Christian Raftopoulos, Philippe Hantson, François Jamar, Pierre-François Laterre, Jonathan Dugernier, Gregory Reychler, Xavier Wittebole, Jean Roeseler, Virginie Depoortere, Thierry Sottiaux, Jean-Bernard Michotte, Rita Vanbever, Thierry Dugernier, Pierre Goffette, Marie-Agnes Docquier, Christian Raftopoulos, Philippe Hantson, François Jamar, Pierre-François Laterre

Abstract

Background: Volume-controlled ventilation has been suggested to optimize lung deposition during nebulization although promoting spontaneous ventilation is targeted to avoid ventilator-induced diaphragmatic dysfunction. Comparing topographic aerosol lung deposition during volume-controlled ventilation and spontaneous ventilation in pressure support has never been performed. The aim of this study was to compare lung deposition of a radiolabeled aerosol generated with a vibrating-mesh nebulizer during invasive mechanical ventilation, with two modes: pressure support ventilation and volume-controlled ventilation.

Methods: Seventeen postoperative neurosurgery patients without pulmonary disease were randomly ventilated in pressure support or volume-controlled ventilation. Diethylenetriaminepentaacetic acid labeled with technetium-99m (2 mCi/3 mL) was administrated using a vibrating-mesh nebulizer (Aerogen Solo(®), provided by Aerogen Ltd, Galway, Ireland) connected to the endotracheal tube. Pulmonary and extrapulmonary particles deposition was analyzed using planar scintigraphy.

Results: Lung deposition was 10.5 ± 3.0 and 15.1 ± 5.0 % of the nominal dose during pressure support and volume-controlled ventilation, respectively (p < 0.05). Higher endotracheal tube and tracheal deposition was observed during pressure support ventilation (27.4 ± 6.6 vs. 20.7 ± 6.0 %, p < 0.05). A similar penetration index was observed for the right (p = 0.210) and the left lung (p = 0.211) with both ventilation modes. A high intersubject variability of lung deposition was observed with both modes regarding lung doses, aerosol penetration and distribution between the right and the left lung.

Conclusions: In the specific conditions of the study, volume-controlled ventilation was associated with higher lung deposition of nebulized particles as compared to pressure support ventilation. The clinical benefit of this effect warrants further studies. Clinical trial registration NCT01879488.

Keywords: Aerosol delivery; Invasive mechanical ventilation; Ventilation mode; Vibrating-mesh nebulizer.

Figures

Fig. 1
Fig. 1
Planar imaging to assess aerosol lung deposition during invasive mechanical ventilation. The ventilator was equipped with a 160-cm, 22-mm inner-diameter ventilator circuit (IMMED, Bruxelles, Belgium) including a 7-cm proximal flow sensor (PFS, Hamilton Medical, Bonaduz, Switzerland) positioned between the Y-piece and the catheter mount, a protection filter and the vibrating-mesh nebulizer. The patient was in semirecumbent position at 15° with the head turned right to avoid the overlap of the thorax, the ventilator circuit and the gamma camera (at 10 cm of the sternum)
Fig. 2
Fig. 2
Summary of the protocol
Fig. 3
Fig. 3
High intersubject variability of aerosol penetration through the lungs and its deposition between the right and the left lung during pressure support ventilation and volume-controlled ventilation. a A penetration index equal to 1 indicated a linear aerosol penetration from the inner to the outer part of the lungs. Particles deposition was limited to the central airways with both ventilation modes. b A right/left lung deposition ratio equal to 1 indicated a similar aerosol deposition in both lungs. Right lung deposition was predominant with both ventilation modes, especially during volume-controlled ventilation. c Scintigraphic images of aerosol lung deposition in two patients in volume-controlled ventilation (left) and two patients in pressure support ventilation (right). With both ventilation modes, the first patient on the left benefits of a symmetrical aerosol lung deposition while a predominant left lung or right lung deposition is depicted in the patient on the right. Aerosol penetration from the inner to the outer lung region varies also among patients

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Source: PubMed

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