Effect of continuous positive airway pressure combined to nebulization on lung deposition measured by urinary excretion of amikacin

Reychler, Gregory; Leal, Teresinha; Roeseler, Jean; Thys, Frédéric; Delvau, Nicolas; Liistro, Giuseppe

doi:10.1016/j.rmed.2007.06.003

« Previous Next »Respiratory Medicine
Volume 101, Issue 10 , Pages 2051-2055, October 2007

Effect of continuous positive airway pressure combined to nebulization on lung deposition measured by urinary excretion of amikacin

Gregory Reychler
- Department of Physical Medicine and Rehabilitation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
- Department of Pediatry, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
- Corresponding author. Department of Physical Medicine and Rehabilitation Cliniques, Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium. Tel.: +3227641939; fax: +3227648906.
Teresinha Leal
- Department of Clinical Chemistry, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
Jean Roeseler
- Department of Physical Medicine and Rehabilitation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
- Department of Emergency and Intensive Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
Frédéric Thys
- Department of Emergency and Intensive Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
Nicolas Delvau
- Department of Emergency and Intensive Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
Giuseppe Liistro
- Pneumology Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium

Received 16 December 2006; accepted 3 June 2007. published online 15 July 2007.

Summary

Continuous positive airway pressure (CPAP) is frequently used in patients attending emergency units. Its combination with nebulization is sometimes necessary in those patients presenting with a CPAP dependency.

Study objective

To compare lung deposition of amikacin delivered by a classical jet nebulizer (SideStream; Medic-Aid; West Sussex, UK) used alone (SST) or coupled to a CPAP device (Boussignac; Vygon; Belgium).

Method

Amikacin (1g) was nebulized with both devices in six healthy subjects during 5min on spontaneous breathing. A 1-week wash-out period between each nebulization was applied. Lung deposition was indirectly assessed by urinary monitoring of excreted amount of amikacin.

Results

Total daily amount of amikacin excreted in the urine was significantly lower with CPAP than with SST (1.97% initial dose versus 4.88% initial dose, p<0.001) with a corresponding mean ratio CPAP/SST of 0.41. The residual amount of amikacin in the nebulizer was higher with CPAP than with SST (607mg versus 541mg) but the difference was not significant (p=0.35).

Conclusion

These data suggest that the amount of amikacin delivered to healthy lungs is 2.5-fold lower with CPAP than with SST for the same nebulization time and that the nebulization time when using CPAP should be increased to reach the same amount of drug delivered with a classical jet nebulizer.

KEYWORDS: Nebulizer, Lung deposition, Continuous positive airway pressure, Urinary monitoring