Abstract: We aimed to quantify Soft Mist Inhalers (SMI) delivery to spontaneous breathing model\nand compare with different adapters via endotracheal tube during mechanical ventilation or by\nmanual resuscitation. A tiotropium SMI was used with a commercial in-line adapter and a T-adapter\nplaced between the Y-adapter and the inspiratory limb of the ventilator circuit during mechanical\nventilation. The SMI was actuated at the beginning of inspiration and expiration. In separate\nexperiments, a manual resuscitator with T-adapter was attached to endotracheal tube, collecting\nfilter, and a passive test lung. Drug was eluted from collecting filters with salt-based solvent and\nanalyzed using high-performance liquid chromatography. Results showed the percent of SMI label\ndose inhaled was 3-fold higher with the commercial in-line adapter with actuation during expiration\nthan when synchronized with inspiration. SMI with T-adapter delivery via ventilator was similar\nto inhalation (1.20%) or exhalation (1.02%), and both had lower delivery dose than with manual\nresuscitator (2.80%; p = 0.01). The inhaled dose via endotracheal tube was much lower than inhaled\ndose with spontaneous breathing (22.08%). In conclusion, the inhaled dose with the commercial\nadapter was higher with SMI actuated during expiration, but still far less than reported spontaneous\ninhaled dose.
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