Help Centre: FAQs about Aerogen Ultra

Aerogen Ultra


Can both valved & open aerosol masks be used with Aerogen Ultra?

All standard aerosol masks can be connected to the Aerogen Ultra, but a valved mask (included) is best for optimal aerosol deposition 20. Use a flow rate of 1-6L/min with an open face mask and do not exceed 2L/min with a paediatric patient. Never use a closed face mask with the Aerogen Ultra.




Can a filter be used with the Aerogen Ultra to reduce emission of drugs?

Currently we do not have an approved filter which can be attached to the valved mouthpiece.




How do I clean the Aerogen Ultra?

The Aerogen Ultra is a single patient use device which is qualified for 20 intermittent use treatments (at a rate of four doses per day over 5 days) or 3 hours of continuous use. You can remove excess rain-out from the Aerogen Ultra periodically (hourly with continuous nebulisation). To ensure optimal performance of the Aerogen Ultra remove any residue by rinsing through with sterile water, shake off excess and allow to air dry.




How do you remove residue in the nebulisation chamber after use of viscous drugs?

In order to remove any residues of viscous drugs you can nebulise a few drops of normal saline.




How long can I use the Aerogen Ultra?

The Aerogen Ultra is a single patient use device which is qualified for 20 intermittent use treatments (at a rate of four doses per day over 5 days) or 3 hours of continuous use.




What medications can the Aerogen Solo/ Ultra deliver?

The Aerogen Solo with Ultra can nebulise physician-prescribed medications for inhalation which are approved for use with a general purpose nebuliser. For more information on specific drugs and dosages please contact our Clinical team at msl@aerogen.com or within US/Canada at MedicalScience@aerogen.com.




Can we use multiple types of drug in the same Aerogen Solo?

You don’t need a different Aerogen Solo to nebulise different drugs but when nebulising viscous drugs you may need to add a few drops of saline to clear the mesh before nebulising the next drug. Always refer to the drug manufacturer’s guidelines before combining drugs for nebulisation.




Should I adjust the drug dosage as I’m using the Aerogen Ultra?

The Aerogen Ultra can be used to nebulise all physician prescribed drugs approved for use with a general purpose nebuliser. Aerogen Ltd cannot provide specific advice on medication dose as it does not have regulatory approvals for drug/device combinations at this time. Information on drug dosing with specific nebulisers must be sourced from the manufacturer’s approved prescribing information for the inhaled formulation, bearing in mind published clinical research examining the efficiency of the different nebuliser technologies in terms of delivering therapeutic/effective drug levels in the lungs for specific medications. Should you require information regarding published clinical research for nebulisation of specific medications with Aerogen’s devices then please contact our Clinical team directly at msl@aerogen.com or within US/Canada at medicalscience@aerogen.com.

 

 




How long does it take to deliver a unit dose?

The flow rate of the Aerogen Solo used with the Ultra is > 0.2ml/min with an average of 0.38ml/min. For a standard 3ml dose this would therefore take 7 minute 53 seconds13.




How much medication is left at the end of a treatment?

Medication left in the nebuliser at the end of the treatment is minimal: < 0.1mL13.




How much medication can be given at one time?

The medication cup of the Aerogen Solo nebuliser used with the Aerogen Ultra can hold up to 6mL of medication.




How does the lung deposition of drugs with the Aerogen Ultra compare to standard nebulisers?

Spontaneously breathing subjects showed six times greater deposition with the Aerogen Ultra compared to jet nebulisers18.




What evidence is available for why a valved mask as compared to a non-valved aerosol mask is optimal for use with the Ultra?

Ari et al., (2015) have shown that a valved mask will provide optimal aerosol dose to the patient compared to a standard open face mask. The aerosol dose is significantly improved with the valved facemask and also it is comparable to mouthpiece (comparison at 2L/min flow) 25.




When should I use the mouthpiece or mask with paediatric patients?

A clinical judgement should be made in all cases as to whether the patients can cooperate and can hold the mouthpiece in their lips. In addition, the American Association Respiratory Care Clinical Practice Guidelines on aerosol delivery26 recommend mouthpiece use on patients ≥ 3 years old. If the patient cannot use the mouthpiece then a mask should be used. Make sure the mask fits securely on the face of the patient and a good seal is achieved.



References

1. Ari A, Areabi H, Fink JB, Cpft PT, Areabi H, Rrt M et al. Evaluation of aerosol generator devices at 3 locations in humidified and non-humidified circuits during adult mechanical ventilation. Respir Care 2010; 55: 837–844. 2. Lin HL, Fink JB, Zhou Y, Cheng YS. Influence of moisture accumulation in inline spacer on delivery of aerosol using metered-dose inhaler during mechanical ventilation. Respir Care 2009; 54: 1336–1341. 3. Kaminsky DA, Bates JH, Irvin CG. Effects of cool, dry air stimulation on peripheral lung mechanics in asthma. Am J Respir Crit Care Med 2000; 162: 179–186. 4. Saeed H, Abdelrahim MEA, Fink JB. Stability of commonly nebulised drugs in heated and humid condition. Med Sci 2018; 7: 269–76. 5. Ari A, Atalay OT, Harwood R, Sheard MM, Aljamhan EA, Fink JB. Influence of nebuliser type, position, and bias flow on aerosol drug delivery in simulated paediatric and adult lung models during mechanical ventilation. Respir Care 2010; 55: 845–851. 6. Berlinski A, Willis JR. Albuterol delivery by 4 different nebulisers placed in 4 different positions in a paediatric ventilator in vitro model. Respir Care 2013; 58: 1124–1133. 7. Ari A, Fink JB. Aerosol Drug Delivery During Mechanical Ventilation: Devices, Selection, Delivery Technique, and Evaluation of Clinical Response to Therapy. Clin Pulm Med 2015; 22: 79–86. 8. Reminiac F, Vecellio L, Loughlin RM, Le Pennec D, Cabrera M, Vourc’h NH et al. Nasal high flow nebulisation in infants and toddlers: An in vitro and in vivo scintigraphic study. Pediatr Pulmonol 2017; 52: 337–344. 9. Li J, Gong L, Ari A, Fink JB. Decrease the flow setting to improve trans‐nasal pulmonary aerosol delivery via “high‐flow nasal cannula” to infants and toddlers. Pediatr Pulmonol 2019; : ppul.24274. 10. Aerogen Solo System Instruction Manual. Aerogen Ltd. P/N 30-354, Part No. AG-AS3050.  11. Alcoforado L, Ari A, De Melo Barcelar J, Brandao SS, Fink JB, Dornelas De Andrade A. Comparison of Aerosol Deposition with Heated and Unheated High Flow Nasal Cannula (HFNC) in Healthy Adults. Poster Present ATS 2016. 12. Reminiac F, Vecellio L, Bodet-Contentin L, Gissot V, Le Pennec D, Salmon Gandonniere C et al. Nasal high-flow bronchodilator nebulisation: a randomized cross-over study. Ann Intensive Care 2018; 8: 128. 13. Dhand R. Basic techniques for aerosol delivery during mechanical ventilation. Respir Care 2004; 49: 611– 22. 14. Berlinski A, Willis JR. Effect of Tidal Volume and Nebuliser Type and Position on Albuterol Delivery in a Paediatric Model of Mechanical Ventilation. Respir Care 2015; 60: 1424–1430. 15. Dugernier J, Reychler G, Wittebole X, Roeseler J, Depoortere V, Sottiaux T et al. Aerosol delivery with two ventilation modes during mechanical ventilation: a randomized study. Ann Intensive Care 2016; 6: 73. 16. MacIntyre NR, Silver RM, Miller CW, Schuler F, Coleman RE. Aerosol delivery in intubated, mechanically ventilated patients. Crit Care Med 1985; 13: 81–84. 17. Galindo-Filho VC, Ramos ME, Rattes CS, Barbosa AK, Brandao DC, Brandao SCS et al. Radioaerosol Pulmonary Deposition Using Mesh and Jet Nebulisers During Noninvasive Ventilation in Healthy Subjects. Respir Care 2015; 60: 1238–1246. 18. Dugernier J, Hesse M, Vanbever R, Depoortere V, Roeseler J, Michotte JB et al. SPECT-CT Comparison of Lung Deposition using a System combining a Vibrating-mesh Nebuliser with a Valved Holding Chamber and a Conventional Jet Nebuliser: a Randomized Cross-over Study. Pharm Res 2017; 34: 290–300. 19. Abdelrahim ME, Plant P, Chrystyn H. In-vitro characterisation of the nebulised dose during non-invasive ventilation. J Pharm Pharmacol 2010; 62: 966–972. 20. Berlinski A, Velasco J. Albuterol Delivery Efficiency in a Paediatric Model of Noninvasive Ventilation With a Single-Limb Circuit. Respir Care 2019; : respcare.06622. 21. Velasco J, Berlinski A. Albuterol Delivery Efficiency in a Paediatric Model of Noninvasive Ventilation With Double-limb Circuit. Respir Care 2018; 63: 141–146. 22. Berlinski A, Kumaran S. Particle Size Characterization of Nebulised Albuterol Delivered by a Vibrating Mesh Nebuliser Through Paediatric Endotracheal Tubes. POster Present ATS 2016. 23. Dubus JC, Vecellio L, De Monte M, Fink JB, Grimbert D, Montharu J et al. Aerosol deposition in neonatal ventilation. Pediatr Res 2005; 58: 10–14. 24. Ní Mhurchú Sorcha, Brady Paul, McKenna Cathy, Bennett Gavin , Joyce Mary, Sweeney Louise MR. Effect of Nebuliser Position on Aerosol Delivery during Mechanical Ventilation of a Neonate. Irish Thorac Soc poster 2018. 25. Ari A, Fink JB, de Andrade AD, AlHamad B, Sheard M, AlHamad B et al. Performance Comparisons of Jet and Mesh Nebulisers Using Different Interfaces in Simulated Spontaneously Breathing Adults and Children. J Aerosol Med Pulm Drug Deliv 2015; 28: 281–289. 26. Ari A, Pt R, Faarc C, Restrepo RD, Faarc R. AARC Clinical Practice Guideline Aerosol Delivery Device Selection for Spontaneously Breathing Patients: 2012. 2012. doi:10.4187/respcare.01756. 27. Aerogen Pro System Instruction Manual. Aerogen Ltd. Part No. AG-AP1080 P/N 30-040. Aerogen Ltd.

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