The Effect of Different Interfaces on Aerosol Delivery in Simulated Spontaneously Breathing Adult with Tracheostomy

• Main Author: Bugis, Alaa Ahmed
• Format: Others
• Published: Digital Archive @ GSU 2010
• Subjects: Alaa; Bugis; Wright; Tracheostomy; Interfaces; Aerosol; Medicine and Health Sciences
• Online Access: http://digitalarchive.gsu.edu/rt_theses/9; http://digitalarchive.gsu.edu/cgi/viewcontent.cgi?article=1007&context=rt_theses

Background: The delivery of an aerosol via a tracheostomy tube has been previously described with both a tracheostomy collar and a T-piece, but not with a Wright mask, or aerosol mask. The primary purpose of this study was to quantify lung doses using different interfaces: tracheostomy collar, Wright mask, and aerosol mask. The secondary purposes were to compare albuterol delivery between an opened vs. a closed fenestration hole and also to determine the effect of inspiratory time:expiratory time (I:E) ratio on aerosol delivery. Methods: A teaching mannequin (Medical Plastic Labs, Gatesville, TX) with a tracheostomy opening was used. Two of the mannequin's bronchi were connected to a "Y" adaptor, which was attached to a collecting filter (Respirgard ™ II 303, Vital Signs, Englewood, CO), which was connected to a breathing simulator (Harvard Apparatus Dual Phase Control Respirator Pump, Holliston, MA) through a corrugated tube. Settings for spontaneous breathing were respiratory rate 20/min, and tidal volume 400 mL. The I:E ratios were adjusted in the first and second comparisons at 2:1 and 1:2, respectively. The nebulizer was operated by a flow meter (Timemeter, St. Louis, MO) at 8 L/min with 100% oxygen. In every condition, the flow was discontinued at the end of nebulization. The nebulizer was attached to the tracheostomy collar (AirLife™, Cardinal Health, McGaw Park, IL) in the first group, the Wright mask (Wright Solutions LLC, Marathon, FL) in the second group, and the aerosol mask (AirLife™, Cardinal Health, McGaw, IL) in the third group. Drug was eluted from the filter and analyzed by spectrophotometry (276 nm). Data Analysis: Paired t-test, one-way analysis of variance (ANOVA), repeated measures ANOVA, post-hoc and pairwise comparisons were performed at the significance level of .05, using PASW version 18.0. Results: Aerosol delivery was greater with the tracheostomy collar than the Wright mask and aerosol mask (p < .05). Closing the fenestration hole increased aerosol deposition significantly at 2:1 ratio (p = .04) compared to opening the fenestration at 1:2 ratio. I:E ratio and aerosol delivery were directly related. Increasing I:E ratio from 1:2 to 2:1 improved aerosol delivery significantly with tracheostomy collar-fenestration opened (p = .009), Wright mask (p = .02) and aerosol mask (p = .01). Conclusion: This study indicates that the use of a tracheostomy collar is the best method of delivering aerosol therapy among the three interfaces. The I:E ratio of 2:1 caused greater aerosol deposition than 1:2 ratio. The aerosol deposition was better when the fenestration hole was closed compared with opened fenestration.