Performance of different nebulizers in clinical use for Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC)

Abstract

Objective: Technical ex-vivo comparison of commercial nebulizer nozzles used for Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC). Methods: The performance of four different commercial nebulizer nozzles (Nebulizer; HurriChem; MCR-4 TOPOL; QuattroJet) was analysed concerning: i) technical design and principle of operation, ii) operational pressure as function of the liquid flow rate, iii) droplet size distribution via laser diffraction spectrometry, iv) spray cone angle, spray cone form as well as horizontal drug deposition by image-metric analyses and v) chemical resistance via exposing to a cytostatic solution and chemical composition by means of spark optical emission spectral analysis. Results: The Nebulizer shows quasi an identical technical design and thus also a similar performance (e.g., mass median droplet size of 29 micrometer) as the original PIPAC nozzles (MIP/ CapnoPen). All other nozzles show more or less a performance deviation to the original PIPAC nozzles. The HurriChem has a similar design and principle of operation as the Nebulizer, but provides a finer aerosol (22 micrometer). The principle of operation of MCR-4 TOPOL and QuattroJet differ significantly from that of the original PIPAC nozzle technology. The MCR-4 TOPOL offers a hollow spray cone with significantly larger droplets (50 micrometer) than the original PIPAC nozzles. The QuattroJet generates an aerosol (22 micrometer) similar to that of the HurriChem but with improved spatial drug distribution. Conclusion: The availability of new PIPAC nozzles is encouraging but can also have a negative impact if their performance and efficacy is unknown. It is recommended that PIPAC nozzles that deviate from the current standard should be subject to bioequivalence testing and implementation in accordance with the IDEAL-D framework prior to routine clinical use.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive any funding

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Data Availability

All data produced in the present work are contained in the manuscript

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