The Effect of Different Closed Suction Catheter Designs and pMDI Adapters on Aerosol Delivery in Simulated Adult Mechanical Ventilation With and Without Exhaled Humidity

Respiratory Care
Jacqueline P WilliamsJames B Fink

Abstract

Closed suction catheters are commonly used with pressurized metered-dose inhalers (pMDIs) in ventilator-dependent patients receiving bronchodilator therapy. Although heated/humidified circuits result in a decrease in drug delivery, no studies have investigated the impact of a closed suction catheter with a pMDI on aerosol delivery during mechanical ventilation. We sought to quantify aerosol delivery with a variety of closed suction catheters and pMDI adapters in a simulated ventilator-dependent adult lung model with and without exhaled humidity. A ventilator (tidal volume 450 mL, PEEP 5 cm H2O, breathing frequency 15 breaths/min, peak flow 60 L/min, and bias flow 2 L/min) was attached to 3 closed suction catheter designs (T-piece, double swivel elbow, and a multi-access port) with pMDI adapters (small- and large-unidirectional adapters, a bidirectional adapter, and a built-in port) connected to an endotracheal tube (ETT) with a collecting filter and a passive test lung. To simulate exhaled humidity, a heated humidifier was placed between the collection filter and the distal tip of the ETT, set at 36°C. Experiments without exhaled humidity were performed with no heat and humidification. For each test, 4 puffs of albuterol sulfat...Continue Reading

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