LAUSR

Introduction: Some pediatric patients treated for respiratory failure with noninvasive ventilation (NIV) also receive inhaled drugs. Soft mist (SMI) and pressurized metered dose inhalers (pMDI) are used to deliver albuterol during pediatric NIV with single limb ventilator circuit. We hypothesize that SMI with adapter and pMDI with adapter will deliver the highest and lowest amount of albuterol respectively. Materials and Methods: A breathing simulator (VT 200ml, RR 20 breaths/min, I:E ratio 1:3) connected in series to a filter (lung dose) and a 5-year old child head/airway model were used. A ventilator (Trilogy, NIV mode, 15/5 cm H2O) with single-limb circuit was connected to an oronasal mask. The pMDI (Ventolin HFA, 90 µg/puff) was tested with an adapter and a collapsible spacer, while the SMI (Combivent Respimat, 100 µg/puff) was tested with 2 adapters. Ten puffs actuated at the beginning of inhalation @ 1-min intervals were used for each experiment (done in quadruplicate). The outcome variables were lung dose (µg), and cost to deliver equivalent doses to a previously tested low cost nebulizer (lung dose 137.5 ± 45 µg/loading dose 2500 µg) expressed as multiples of the nebulizer’s cost (xNEB). Albuterol mass was determined by spectrophotometry. Results: (Mean ± SD) *P = 0.03 vs. pMDI/adapter Conclusion: Albuterol delivery during NIV with a single-limb ventilator circuit in a model of a spontaneously breathing child using pMDI/SMI is inefficient and is not a cost-efficient when compared to nebulization.