Abstract
We compared the amounts of bronchodilator delivered through an endotracheal tube (ETT) to a laboratory model of the neonate requiring ventilatory support. METHODS & MATERIALS: Albuterol (Proventil) from a nebulizer driven by a 6 L/min gas flow was delivered in three ways. In Method 1, the nebulizer was placed just proximal to the patient Y on the inspiratory limb of a ventilator circuit. In Method 2, the nebulizer was placed in-line on the inspiratory limb of a ventilator circuit with a 5-inch reservoir tube between the nebulizer and the patient Y. In Method 3, the outlet of the nebulizer T-piece was connected directly to the ETT. With the first two methods, ventilation was provided with a Sechrist IV-100B neo-natal ventilator, using continuous-flow and pressure-limited ventilation. In Meth-od 3, nebulized drug was delivered by manually inflating the lung model. Uniform ventilator settings were used with all three methods: rate 30 breaths/min, in-spiratory time 0.5 s, and peak inspiratory pressure 20 cm H2O. Aerosolized drug delivery at the end of the ETT was measured using a spectrophotometric tech-nique. RESULTS: The nebulizer proximal to the Y delivered 0.97% of the total dose placed in the nebulizer reservoir to the end of the ETT. The use of the res-ervoir tubing increased this to 1.78% of the dose. Manual inflation resulted in de-livery of 1.03% of the dose. Drug delivery was significantly greater with use of res-ervoir tubing than with the other two methods (p < 0.05), which did not differ from each other. CONCLUSION: The presence of a 5-inch reservoir between the gas-powered nebulizer and the Y adapter on the inspiratory limb of the ventilator circuit significantly increases the aerosolized bronchodilator delivered through a neonatal ETT, although only a small fraction of the total dose is delivered with any of the three methods examined.
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