Effects of Heat and Moisture Exchangers and Exhaled Humidity on Aerosol Deposition in a Simulated Ventilator-Dependent Adult Lung Model.

Ari, Arzu; Alwadeai, Khalid S; Fink, James B

BACKGROUND Many in vitro models report higher inhaled dose with dry versus heated humidity. Heat-and-moisture exchangers (HMEs) provide passive humidity in ventilator-dependent patients but act as a barrier to aerosol. The HMEs designed to allow aerosol delivery (HME-ADs) have not been well described. The purpose of this study is to determine the impact on aerosol deposition of HME-ADs with and without active exhaled humidity in a simulated ventilator-dependent adult model. METHODS We used an in vitro lung model consisting of an intubated teaching mannequin with an endotracheal tube of 8.0 mm inner diameter with bronchi directly attached to a collecting filter and passive rubber test lung to provide testing without active exhaled humidity. To simulate exhaled humidity, a Cascade humidifier (37°C and 100% relative humidity) was placed between the collecting filter and test lung, simulating body temperature and pressure saturated exhaled humidity at the bronchi. Albuterol sulfate (2.5 mg/3 mL) was administered with a mesh nebulizer (Aerogen Solo) placed in the inspiratory limb of the ventilator circuit at the Y-piece, with no HME in place (control) and with 3 HME-AD devices, including the CircuVent, Humid-Flo, and AirLife, with and without exhaled humidity. Drug was eluted from the collecting filter and analyzed with spectrophotometry. Student t tests and analysis of variance were used for data analysis (P < .05). RESULTS The percentage of drug dose delivered (mean ± SD) distal to the bronchi in the control experiments was greater than all of the HME-ADs without exhaled humidity 18 ± 0.7 and with active exhaled humidity 10.8 ± 0.2% (P < .005). Without exhaled humidity, aerosol delivery with the CircuVent (12.6 ± 0.8), Humid-Flo (15.3 ± 0.8), and AirLife (12.0 ± 0.5) was less than control (P < .001, P = .01 and P < .001, respectively). In contrast, with exhaled humidity, no difference was found between control and HME-ADs (P = .89). Also, a greater variation between control and the 3 HME-ADs was observed without exhaled humidity. Drug delivery without exhaled humidity exceeded aerosol deposition obtained with exhaled humidity in all conditions tested in this study. CONCLUSIONS In this model simulating active exhaled humidity, aerosol drug delivery was lower and more consistent with both control and the HME-ADs than with the standard nonhumidified model. Further studies are needed to determine whether greater deposition in a dry model is an artifact of the model that does not simulate exhaled humidity.