JET NEBULIZATION OF BUDESONIDE SUSPENSION INTO A NEONATAL VENTILATOR CIRCUIT - SYNCHRONIZED VERSUS CONTINUOUS NEBULIZER FLOW

To determine the dose of inhaled budesonide suspension in the treatmen t of preterm infants with ventilator-dependent lung disease, we measur ed the dose of nebulized budesonide delivered through an endotracheal tube (ETT), using a test lung and filters. The effect of delivering th e nebulized aerosol to two different locations in the same ventilatory circuit was evaluated, in addition, a new synchronized let nebulizer was tested. The median drug delivery to the test lung was 0.3% (range, 0-0.4%) of the nominal dose when the nebulizer activated by continuou s gas flow was inserted into the inspiratory line of the circuit. Drug delivery could be increased to 0.7% (range, 0.5-0.8%) by delivering t he nebulizer output directly to the ETT. When using the synchronized j et nebulizer, drug delivery was 1.1% (range, 0.8-1.6%). The particle s ize of aerosol emerging from the ETT was 2.14 mu m. The nebulization l ime with the synchronized nebulizer set-up was 38 min, while the other set-ups delivered an equal Volume of solution in 6-7 min, Drug delive ry of 0.3-1.1% to the test lung illustrates the problems encountered i n aerosol treatment of intubated neonates. We conclude that the delive ry of budesonide to the test lung can be increased by delivering the n ebulizer output to the ETT directly. Using synchronized nebulization d uring inspiration only can achieve further increases in drug delivery, and wastage of drug during expiration is decreased. Synchronized nebu lization may, therefore, have an important place in the delivery of ex pensive aerosolized drugs. 1997 Wiley-Liss, Inc.