Aerosol drug delivery to spontaneously-breathing preterm neonates: lessons learned.
Aerosol drug delivery to spontaneously-breathing preterm neonates: lessons learned.
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DOI：
10.1186/s12931-020-01585-9
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发表时间：
2021-02-26
影响因子：
5.8
通讯作者：
Pillow J
中科院分区：
文献类型：
--
作者：
Bianco F;Salomone F;Milesi I;Murgia X;Bonelli S;Pasini E;Dellacà R;Ventura ML;Pillow J
给接受无创通气（NIV）的早产儿提供药物是气雾剂药物最具挑战性的情况之一。这类婴儿的解剖结构和复杂的（病理）生理特征突出了这一挑战。关键的生理限制包括低肺容量、低依从性和不规则呼吸频率，这显著减少了肺沉积。这些因素是早产所固有的，因此可以看作是影响肺沉积的内在因素。然而，也有许多外部因素影响肺沉积：这些因素包括气溶胶发生器的选择及其在通风回路中的配置、药物配方、气溶胶粒径分布、NIV类型的选择以及给药系统与患者之间的患者界面。总之，这些外在因素提供了一个机会，以优化肺沉积的治疗气溶胶，并最终，治疗的疗效。在这篇综述中，我们首先提供了影响早产儿肺沉积的内在和外在因素的综合特征，然后修订了临床尝试在NIV期间向早产儿输送治疗性气雾剂，这几乎完全与表面活性剂气雾剂的非侵入性输送有关。在这篇综述中，我们为解释现有的关于新生儿气溶胶输送的实验和临床数据提供了线索，我们还描述了一个可测量的变量框架和可用的工具，包括体外和体内模型，在开发用于吸入的药物时应该考虑到这一重要但服务不足的患者群体。
Delivery of medications to preterm neonates receiving non-invasive ventilation (NIV) represents one of the most challenging scenarios for aerosol medicine. This challenge is highlighted by the undersized anatomy and the complex (patho)physiological characteristics of the lungs in such infants. Key physiological restraints include low lung volumes, low compliance, and irregular respiratory rates, which significantly reduce lung deposition. Such factors are inherent to premature birth and thus can be regarded to as the intrinsic factors that affect lung deposition. However, there are a number of extrinsic factors that also impact lung deposition: such factors include the choice of aerosol generator and its configuration within the ventilation circuit, the drug formulation, the aerosol particle size distribution, the choice of NIV type, and the patient interface between the delivery system and the patient. Together, these extrinsic factors provide an opportunity to optimize the lung deposition of therapeutic aerosols and, ultimately, the efficacy of the therapy. In this review, we first provide a comprehensive characterization of both the intrinsic and extrinsic factors affecting lung deposition in premature infants, followed by a revision of the clinical attempts to deliver therapeutic aerosols to premature neonates during NIV, which are almost exclusively related to the non-invasive delivery of surfactant aerosols. In this review, we provide clues to the interpretation of existing experimental and clinical data on neonatal aerosol delivery and we also describe a frame of measurable variables and available tools, including in vitro and in vivo models, that should be considered when developing a drug for inhalation in this important but under-served patient population.
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影响因子：
3.7
作者：
Rey-Santano C;Mielgo V;Gastiasoro E;Valls-i-Soler A;Murgia X
通讯作者：
Murgia X
DOI：
10.1053/siny.2002.0129
发表时间：
2002-10-01
期刊：
Seminars in neonatology : SN
影响因子：
--
作者：
Attar, Mohammad Ali;Donn, Steven M
通讯作者：
Donn, Steven M
影响因子：
3.7
作者：
Dani, Carlo;Corsini, Iuri;Buonocore, Giuseppe
通讯作者：
Buonocore, Giuseppe
影响因子：
5.8
作者：
Bianco, F.;Ricci, F.;Salomone, F.
通讯作者：
Salomone, F.
影响因子：
3.6
作者：
ADAMS, FH;TOWERS, B;NOZAKI, M
通讯作者：
NOZAKI, M