الفهرس 
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Abstract
Purpose
The aim of the present work was Comparative study of the efficacy of different devices; Sidestream Jet Nebuliser, Aeroneb pro nebulizer and Aerochamber MV, on delivery of salbutamol to invasively ventilated patients.
Materials and Methods
In vivo study
The study included 12, randomly selected 6 males and 6 females, invasively ventilated patients; each patient was given short acting bronchodilator (salbutamol) by the three different devices; Sidestream Jet Nebuliser, Aeroneb pro nebulizer and Aerochamber MV, on three alternate days with one day as a wash out period between each two administration.
Selection of device was done randomly.
Urine samples were collected at 0.5 hr post dosing indicating relative bioavailability to the lungs.
Solid phase extraction followed by High Performance Liquid chromatography (HPLC) were used to isolate the drug from urine samples.
Ex-vivo study
On the washout days in the study, an ex-vivo study was done. The study was made by placing the three tested inhalation methods in the ventilation circuit and placing an electrostatic filter between the patient’s endotracheal tube and the administration method to collect all the drug that could reach the patient. Hence three filters were collected from each patient and the amount of salbutamol obtained by sonication and quantified by HPLC.
In vitro study
The amount of salbutamol delivered to the lung by the three previously mentioned inhalation method were determined using Anderson Cascade Impactor (ACI).
Results
In-vivo results
AERO spacer delivered the highest percentage of the nominal dose (mean 34.776) followed by PRO (mean 9.159) and finally JET (mean 4.420) which delivered the least. The three devices were significant from each other (p< 0.05).
Ex-vivo results
AERO spacer also delivered the highest percent of the nominal dose (mean 65.186) followed by but non significantly different from PRO ( mean 56.634). JET nebulizer delivered the least percent of nominal dose (mean 20.442) and was significant from both the other devices (p =0.00).
In-vitro results
Aerochamber MV spacer had significantly the highest total mass in the impactor (TMI) (p =0.000) followed by PRO then JET ,the4 lowest TMI, and highest FPF (p≤ 0.001) followed by JET then PRO.
Conclusions
Aerosol delivery methods in invasive ventilation circuit should be chosen or substituted with care. Our three results show the greater efficacy of AERO than both the tested nebulizers.
Keys words: Salbutamol, pressurized metered dose inhaler, Spacer, vibrating mesh nebulizer, invasive ventilation, urine, mass median aerodynamic diameter, fine particle dose, fine particle fraction, relative lung bioavailability.