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

作者：Dugernier Jonathan^*; Reychler Gregory; Wittebole Xavier; Roeseler Jean; Depoortere Virginie; Sottiaux Thierry; Michotte Jean Bernard; Vanbever Rita; Dugernier Thierry; Goffette Pierre; Docquier Marie Agnes; Raftopoulos Christian; Hantson Philippe; Jamar Francois; Laterre Pierre Francois

来源：Annals of Intensive Care, 2016, 6(1): 73.

DOI：10.1186/s13613-016-0169-x

• Aerosol delivery
• Ventilation mode
• Invasive mechanical ventilation
• Vibrating-mesh nebulizer

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 (R), 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.

• 出版日期2016-7-22