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- Title
DETERMINATION OF FILTER CHANGE SCHEDULES DURING CONTINUOUS NEBULIZATION OF EPOPRSTENOL.
- Authors
Wollens, Carla; Patzwahl, Leslie; Torbic, Heather; Bauer, Seth; Chatburn, Robert L.
- Abstract
Continuous nebulization of medication during mechanical ventilation has been used for decades. There are informal recommendations regarding filter use in the expiratory limb of the ventilator circuit to protect the exhalation manifold and the need to change them regularly. However, while there are studies of the effects of humidification and nebulization on an expiratory filter, there appears to be no prior research on the specific timing of filter changes, particularly for nebulized Epoprostenol. The purpose of this study was to determine an appropriate filter replacement schedule for continuous nebulization of Epoprostenol during mechanical ventilation. Specifically, we sought to determine filter resistance and inadvertent PEEP (end expiratory airway pressure above set PEEP) and autoPEEP (end expiratory lung pressure above set PEEP) as a function of nebulization time during mechanical ventilation of a lung model. METHODS: A Puritan Bennett 840 ventilator was connected to a QuickLung (IngMar Medical Inc.) lung simulator with compliance = 50 mL / cmH2O, resistance = 20 cmH2O/(L/sec). Ventilator settings: mode = A/C volume control, frequency = 18/min, VT = 450 mL, flow = 35 L/min, PEEP 5 cmH2O . An Aerogen nebulizer was placed between the simulator and the exhalation manifold. Flow and pressure were measured with a Hans-Rudolph pneumotach and amplifier. Nebulized drugs: Flolan (epoprostenol 1.5 mg, in 50 mL diluent containing 3.76 mg glycine, 50 mg mannitol, 2.93 mg NaCl);Veletri (epoprostenol 1.5 mg, in 50 mL 0.9% NaCl diluent containing 100 mg sucrose, 50 mg arginine). Plain normal saline was also nebulized as a control. Measurements of pressure drop across filter (flow = 10, 20 and 30 L/min), lung pressure (PL) and end expiratory pressure at airway opening (PAO), were made at 2 hour intervals over 8 hours of nebulization. Experiments were repeated once. Changes in mean PAO and PL after 8 hours were compared with t-tests (P < 0.05 indicated significance). RESULTS: Summary data are shown in figure. All mean values for PAO and PL after 8 hours were < 0.5 cm H2O and changes were insignificant. CONCLUSION: Continuous nebulization of epoprostenol for 8 hours results in clinically unimportant increases in filter resistance and therefore does not result in inadvertent airway PEEP or lung autoPEEP. There is no need for regular expiratory filter changes. Further study of longer nebulization times and drugs is indicated.
- Publication
Respiratory Care, 2016, Vol 61, Issue 10, pOF20
- ISSN
0020-1324
- Publication type
Academic Journal