Background: In the critically ill, pulmonary vasodilators are often provided off label to intubated patients using continuous nebulization. If additional aerosol therapies such as bronchodilators or antibiotics are needed, vasodilator therapy may be interrupted. This study assesses aerosol systems designed for simultaneous delivery of two aerosols using continuous nebulization and bolus injection without interruption or circuit disconnection. Methods: One i-AIRE dual-port breath-enhanced jet nebulizer (BEJN) or two Aerogen® Solo vibrating mesh nebulizers (VMNs) were installed on the dry side of the humidifier. VMN were stacked; one for infusion and the second for bolus drug delivery. The BEJN was powered by air at 3.5 L/min, 50 psig. Radiolabeled saline was infused at 5 and 10 mL/h with radiolabeled 3 and 6 mL bolus injections at 30 and 120 minutes, respectively. Two adult breathing patterns (duty cycle 0.13 and 0.34) were tested with an infusion time of 4 hours. Inhaled mass (IM) expressed as % of initial syringe activity (IM%/min) was monitored in real time with a ratemeter. All delivered radioaerosol was collected on a filter at the airway opening. Transients in aerosol delivery were measured by calibrated ratemeter. Results: IM%/h during continuous infusion was linear and predictable, mean ± standard deviation (SD): 2.12 ± 1.45%/h, 2.47 ± 0.863%/h for BEJN and VMN, respectively. BEJN functioned without incident. VMN continuous aerosol delivery stopped spontaneously in 3 of 8 runs (38%); bolus delivery stopped spontaneously in 3 of 16 runs (19%). Tapping restarted VMN function during continuous and bolus delivery runs. Bolus delivery IM% (mean ± SD): 20.90% ± 7.01%, 30.40% ± 11.10% for BEJN and VMN, respectively. Conclusion: Simultaneous continuous and bolus nebulization without circuit disconnection is possible for both jet and mesh technology. Monitoring of VMN devices may be necessary in case of spontaneous interruption of nebulization.

中文翻译：

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机械通气期间的多药气雾剂输送。

背景：在危重病人中，经常通过连续雾化的方式向插管患者提供肺血管扩张剂。如果需要额外的气雾剂治疗，例如支气管扩张剂或抗生素，则可能会中断血管扩张剂治疗。本研究评估了气雾剂系统，该系统旨在使用连续雾化和推注注射同时输送两种气雾剂，而无需中断或断开电路。方法：将一台 i-AIRE 双口呼吸增强喷射雾化器 (BEJN) 或两台 Aerogen® Solo 振动网状雾化器 (VMN) 安装在加湿器的干燥侧。VMN 堆叠；一个用于输注，第二个用于推注药物输送。BEJN 由空气提供动力，流速为 3.5 L/min，50 psig。放射性标记的盐水以 5 和 10 mL/h 的速度输注，并分别在 30 分钟和 120 分钟时注射放射性标记的 3 和 6 mL 推注。测试了两种成人呼吸模式（占空比 0.13 和 0.34），输注时间为 4 小时。使用速率计实时监测吸入质量 (IM)，以初始注射器活动的百分比 (IM%/min) 表示。所有输送的放射性气溶胶均被收集在气道开口处的过滤器上。通过校准速率计测量气溶胶输送的瞬态。结果：连续输注期间的 IM%/h 呈线性且可预测，平均值 ± 标准差 (SD)：BEJN 和 VMN 分别为 2.12 ± 1.45%/h、2.47 ± 0.863%/h。BEJN 正常运行。VMN 连续气雾剂输送在 8 次运行中有 3 次自发停止 (38%)；16 次中有 3 次（19%），推注输送自发停止。在连续和推注运行期间点击重新启动的 VMN 功能。推注递送 IM%（平均值±标准差）：BEJN 和 VMN 分别为 20.90% ± 7.01%、30.40% ± 11.10%。结论：喷射技术和网状技术都可以在不断开电路的情况下同时进行连续和推注雾化。如果雾化自发中断，可能需要对 VMN 设备进行监测。