Comparison of Aerosol Delivery Methods for Spontaneously Breathing Tracheostomy Patients
Mary Joyce, Sorcha Murphy, Gavin Bennett, Louise Sweeney & Ronan MacLoughlin
Aerogen, Galway Business Park, Dangan, Galway, H91 HE94, Ireland
Summary
Tracheostomy procedures are continually being utilised as a method for artificial airway management. This procedure is commonly used to promote weaning from mechanical ventilation. It is necessary to deliver therapeutic inhaled aerosols to spontaneously breathing tracheostomy patients for respiratory care. In clinical practice, the drug delivery device required for optimal aerosol drug delivery for tracheostomy patients varies across institutes. One of the challenges to overcome with tracheostomy is the risk of accidental decannulation from the additional weight on the tracheostomy tube from the drug delivery device.
There is no standard protocol for delivering aerosol to a spontaneously breathing adult tracheostomy patient using the vibrating mesh technology. This study investigated the use of a vibrating mesh nebuliser for aerosol delivery to a spontaneously breathing adult tracheostomy patient by utilising different methods of attachment to the tracheostomy tube. The delivery of aerosol was assessed by determining the % inhaled dose in a simulated adult patient by nebulising a 2.0 mL dose of Albuterol sulphate (2 mg/mL) using a vibrating mesh nebuliser attached to a T-piece (34.93 %), T-piece/22M-15F connector (32.06 %), T-piece/catheter mount (33.91 %), aerosol chamber/catheter mount (36.07 %) and aerosol chamber/tracheostomy mask (32.81 %). The mass of drug eluted from the filters was determined using spectrophotometry at 276nm.
A one-way analysis of variance (ANOVA) was performed and an overall significant difference between the attachment methods to the tracheostomy tube was determined with a p-value of 0.02. Therefore, the method selection has a significant effect on the efficiency of aerosol delivery.