Which of the following is the most efficient means of delivering a medicated aerosol during NIV?
a. Nebulizer placed between the leak port, located in the circuit, and the mask
b. MDI placed between the leak port, locat-ed in the circuit, and the mask
c. Use of both high inspiratory and high ex-piratory pressures
d. MDI placed in the circuit with the leak port in the mask
ANS: D
The efficiency of aerosol delivery is similar for a nebulizer and an MDI when the leak port is lo-cated in the circuit and the aerosol device is placed between the leak port and the mask. If the leak port is located in the mask, aerosol delivery is more efficient from an MDI than from a nebu-lizer, provided the MDI is actuated at the beginning of inspiration. Regardless of the device used, more aerosol is lost through the leak port during the exhalation phase of breathing. In-creased aerosol delivery is also more likely when a high inspiratory pressure and a low expiratory pressure are used.
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