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Overcoming the Challenges of Aerosol Delivery to Infants During Non-invasive Ventilation

Dhapare S, Boc ST, Spence B, Bass K, Longest P, Hindle M.

RDD Asia 2018. Volume , 2018: 93-102.

Abstract:

Non-invasive ventilation (NIV) modalities have been widely adopted by clinicians for the management of respiratory diseases in infants. In neonatal practice, where respiratory illnesses such as respiratory distress syndrome (RDS) and bronchopulmonary dysplasia are a major cause of morbidity and mortality, co-administration of aerosols during NIV can offer significant advantages enabling drug delivery for local action within the lungs. However, lung delivery during NIV is inefficient with only between 0.7-4.2% of the nominal dose estimated to be delivered to the lungs. More efficient delivery systems are required. Anatomical factors in infants such as high airway resistance and ventilation challenges, including small tidal volume, short inspiratory times, and rapid breathing rates, have largely resulted in these low lung deliveries with the majority of drug either depositing in the ventilation circuit and nasal cavity or lost during exhalation. Nevertheless, with an understanding of these challenges, aerosol delivery systems can be developed to significantly improve performance. Two different strategies are described; the first proposes reducing the aerosol droplet size to minimize drug aerosol deposition within the ventilation circuit and the nasal cavity, and second, using breath-synchronization to reduce the high drug loss during exhalation. Combining these approaches has the potential to significantly improve lung delivery efficiencies in infants during NIV.