Publications
Journal Articles:
An In Vitro Comparison of Heliox and Oxygen in Aerosol Delivery Using Pediatric High Flow Nasal Cannula, Arzu Ari, Robert Harwood, Meryl Sheard, Patricia Dailey, Jim Fink, Pediatric Pulmonology, 2011
Summary:Drug administration via high flow nasal cannula (HFNC) has been described in pediatrics but the amount of albuterol delivery with an HFNC is not known. The purpose of this study is to quantify aerosol delivery with heliox and oxygen (O2) in a model of pediatric ventilation. It was found that reducing flow rate increases albuterol delivery in this model of pediatrics but decreases impact of heliox. The ability to efficiently deliver inhaled aerosols via nasal cannula may expand clinical options to administer medical aerosols to treat children who will not tolerate the use of masks.
Aerosol delivery to ventilated newborn infants: historical challenges and new directions European Journal of Pediatrics (2011) 170:433-444. Mazela, J & Polin, R
Summary: A review of the research conducted to date and a discussion of the next steps in developing the optimal aerosol delivery system for use in mechanically ventilated neonates.
Influence of nebulizer type, position and bias flow on aerosol drug delivery to a pediatric model of mechanical ventilation. Respiratory Care, July 2010, Dr. A. Ari (Atlanta, GA, USA); J. Fink PhD, RRT, FAARC
Summary: The purpose of this study was to determine the influence of position and bias flow using a jet nebulizer and a vibrating mesh nebulizer (the Aeroneb Solo) on albuterol sulfate delivery in a simulated mechanical ventilated pediatric and adult patients. The vibrating mesh nebulizer (Aeroneb Solo) was more efficient than the jet nebulizer when placed before the Y, and before the humidifier.
Evaluation of Aerosol Generator Devices at 3 Locations in Humidified and Non-humidified Circuits During Adult Mechanical Ventilation Ari et al, Respiratory Care, July 2010
Summary: During simulated ventilation with no bias or trigger flow, placement of a vibrating mesh nebulizer (Aeroneb Solo), an ultrasonic nebulizer or a pMDI in the inspiratory limb 15cm from the Y-piece provided the hightest deposition, under both heated/humidifed and non-humidified conditions. The jet nebulizer was less efficient than the other aerosol generators.
Clearing the Mist From Our Eyes: Bronchodilators, Mechanical Ventilation, New Devices, Locations, and What You Should Know About Bias Flow Respiratory Care, July 2010, Robert M DiBlasi RRT-NPS
Summary: Patients with obstructive lung disease often present with life-threatening respiratory failure, confounded by severe air-flow limitation, dynamic hyperinflation, intrinsic PEEP, reduced pulmonary compliance, hypercarbia, and hemodynamic instability. Despite administration of high doses of bronchodilators and instituting noninvasive ventilation strategies, many patients are incapable of sustaining the high work of breathing that may be required to maintain effective alveolar ventilation. As such, emergency intubation and mechanical ventilation is considered a necessary and “life-saving” intervention.
Aerosol Delivery through Nasal Cannulas: An In Vitro Study Abrhiram R. Bhashyam et al. Journal of Aerosol Medicine, Vol 21, Number 2, 2008
Summary: This study demonstrates that aerosol can be efficiently delivered through a humidified high flow nasal cannula system.
Aerosol Deposition in Neonatal Ventilation Jean C. Dubus et al. Pediatric Research 2005 Volume 58 Number 1
Summary: Lung deposition of inhaled drugs in ventilated neonates has been studied in models of questionable relevance. With conventional nebulizers, pulmonary deposition has been limited to 1% of the total dose. Despite similar amounts of 99mTc-DTPA in the respiratory circuit with all nebulizers, the Aeroneb Pro nebulizers delivered more drug to the lungs than MistyNeb (14.0, 12.6, and 0.5% in terms of percentage of nebulizer charge, respectively; p 0.006).Electronic micropump nebulizers are more efficient to administer aerosols in an animal model of ventilated neonates. Availability of Aerogen’s electronic micropump nebulizers offers new opportunities to study clinical efficacy and risks of aerosol therapy in ventilated neonates.
Case Report: Status Asthmaticus Refractory to Conventional Treatment Patricia Dailey, Neonatal Intensive Care, May/June 2008
Summary: A 15 year old known asthmatic was admitted to the Emergency Roon for an acute exacerbation. She required intubation, receiving several hurs of continuous nebulization and her condition worsened. Her nebulizer was changed to an Aeroneb Solo and was placed in-line on the dry side of the ventilator. Continuous treatements resumed and within 2 hours there was a dramatic improvement in the patient.
Case Report: Significant Apnea and Bradycardic Episodes in Premature Neonate Alleviated by Micropump Nebulizer Mathew Bolinsky, Neonatal Intensive Care, 2008
Summary: Baby Doe was born prematurely at the age of 26 weeks gestation. She was placed on mechanical ventilation for her first 21 days of life. Her chest x-ray showed strekiness as seen with moderate BPD and significant apnea & bradycardic episodes with moderate frequncy. Delivery of Budesonide through the Aeroneb Solo began with positive results. She was completed waned off her oxygen and discharged.
Case Report: High Flow Nasal Cannula Application in an Acute Asthma Exacerbation Patricia Dailey, AARC Conference 2008
Summary: Severe airflow limitation with asthma exacerbations occurs as a result of bronchoconstriction, airway edema and/or mucous plugging leading to dynamic hyperinflation1. Our goal was to provide a noninvasive approach to reduce the patient's work of breathing (WOB).
New Technology Offers New Opportunities: Continuous Bronchodilator Therapy Jim Fink, Respiratory Therapy 2007
Summary:Patients with severe exacerbations of asthma, refractory to standard dose and frequency of inhaled bronchodilators may benefit from continuous bronchodilator therapy (CBT). Multiple factors, including the type of aerosol generating device, particle size, placement in the ventilator circuit, circuit humidity, flow rates and duty cycle influence the efficacy of aerosol delivery and deposition in mechanically ventilated patients.
Clinician's Dilemma Aerosol delivery to Neonates Jim Fink, Neonate Intensive Care, July/August 2007
Summary: Aerosol delivery to the neonate has long been an area of controversy, with strong division in clinician opinions based on a sparseness of evidence. This paper looks at why neonates are different, should dosing be reduced for neonates? It also looks a nebulizer placement, continuous nebulization and contamination during nebulization with four different technologies- jet nebulizers, MDIs, ultasonic nebulizers and vibrating mesh nebulizers.
Choosing the Right Nebulizer Angela D. Hedgeman, BS, RRT-NPS, Neonatal Intensive Care, May/June 2005
Excert: The Aeroneb Pro nebulizer is placed inline between the modified nasal cannula tubing and the delivery tubing of the Vapotherm nasal cannula. Once in place, there is no need to remove the nebulizer.
Use of a Micropump Nebulizer for Aerosolized Medication Delivery in a Ventilated InfantPeggy Bartram, RRT-NPS, RCP, Neonatal Intensive Care, January/February 2005
Drug Delivery Executive: Aerogen Impacts Pulmonary Drug Delivery in the Acute Care Setting Drug Delivery Technology, July/August 2004
Aerosol Delivery to Ventilated Infant and Pediatric Patients James Fink, Respiratory Care, 2004
Summary: Though delivering aerosol to infants poses substantial challenges, it is clear that existing systems can provide effective inhalable therapy, including bronchodilators to anti-inflammatories and anti-infectives such as ribavirin. To overcome the problem of low aerosol deposition and large interpatient and intrapatient variability of deposition, we must understand and be aware of the variables that affect deposition.
The Advantages of Nebulization in the Treatment of Mechanically Ventilated Neonates. Kristin Smith, Neonatal Intensive Care, 2004
Summary: The Aeroneb Pro, by allowing the ventilator to maintain the chosen settings and trigger sensitivity, reduces the risk of harm to neonates receiving aerosolized medications. When caring for such a fragile patient population safety is of utmost importance. The Aeroneb Pro provides this safety over conventional nebulizers.
Posters:
Cost Reduction Using Aeroneb Solo in a Medical ICU Ventilator Population. John S. Emberger, Joel M. Brown II, Lori Killian, AARC Conference 2011
Summary: Poster detailing savings of $57,854 over a five month period when converting from Combivent MDI to unit dose medication using the Aeroneb Solo.
An In Vitro Performances of Aeroneb Solo with Salbutamol During Adult Mechanical Ventilation L Vecellio, E Mercier, J Fink, C Duffy & P Diot, 2008
Summary: The that the Aeroneb® Solo was several fold more efficient than the jet nebulizer in this in vitro simulation of adult mechanical ventilation.
Administraion of Heliox via High Flow Cannula in a Croup Patient Pamel McDermot, AARC Conference 2008
Summary: An 8 month old infant was admitted fro croup started to exhibit moderate to severe stridor. Aproximately 7 hours after admission the patient started to show signs of respiratory distress. An 80/20 heliox mixture was administered through an F&P high flow nasal cannula. Immediate improvement was demonstrated and aerosolized racemic epinephrine was delivered using the Aeroneb Solo via HFNC application.
Aerosol Delivery Through High Flow Nasal Cannula: An In Vitro Comparison with Heliox and Oxygen Patricia A. Dailey, Kyle Walsh, James B. Fink, Robert Harwood, Arzu Ari, AARC Conference 2009
Administration of Heliox and Broncholdilator Aerosol via High Flow Cannula in a Severe Asthmatic Patricia A. Dailey BS, RRT, AARC Conference 2008
Aerosol Delivery During Mechanical Ventilation with High Frequency Oscillation: An In Vitro Evaluation Jim Fink, Paul Barraza & James Bisgard
Summary: The Aeroneb Pro delivered more albuterol during HFO to the airway of the pediatric lung model than the two small volume jet nebulizers, with no modification of ventilator parameters. This level of aerosol delivery without changes in airway pressure may make aerosol delivery during mechanical ventilation with high frequency oscillation more practical.
