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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2016

Open Access 01-12-2016 | Research

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

Authors: Jonathan Dugernier, Gregory Reychler, Xavier Wittebole, Jean Roeseler, Virginie Depoortere, Thierry Sottiaux, Jean-Bernard Michotte, Rita Vanbever, Thierry Dugernier, Pierre Goffette, Marie-Agnes Docquier, Christian Raftopoulos, Philippe Hantson, François Jamar, Pierre-François Laterre

Published in: Annals of Intensive Care | Issue 1/2016

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Abstract

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®, 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.
Clinical trial registration NCT01879488
Appendix
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Metadata
Title
Aerosol delivery with two ventilation modes during mechanical ventilation: a randomized study
Authors
Jonathan Dugernier
Gregory Reychler
Xavier Wittebole
Jean Roeseler
Virginie Depoortere
Thierry Sottiaux
Jean-Bernard Michotte
Rita Vanbever
Thierry Dugernier
Pierre Goffette
Marie-Agnes Docquier
Christian Raftopoulos
Philippe Hantson
François Jamar
Pierre-François Laterre
Publication date
01-12-2016
Publisher
Springer Paris
Published in
Annals of Intensive Care / Issue 1/2016
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-016-0169-x

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