Westmed, a leader in pulmonary medication delivery, introduced the original Circulaire aerosol drug delivery system to the respiratory therapy market in 1997.
In 2008, the Circulaire II was developed and featured two main design improvements: (1) the thick vinyl reservoir bag of the original Circulaire was replaced with a thin-film polyethylene reservoir bag that inflates and deflates much more readily, and (2) the small center-post one-way valve was replaced by a large top-hinged one-way “flapper” valve that is instantly responsive to the patient’s inspiratory effort and does not block the flow of any aerosol particles.
These two design changes have significantly improved the aerosol delivery performance of the Circulaire II, casting it as the top performing pneumatically-driven aerosol delivery device for adults and children.
The Circulaire II uses the conserver principle to double the rate of drug delivery: i.e, approximately two times as much drug in the same time, or less, than all other nebulizers including breath-enhanced and breath-actuated designs, with the Highest FIA (Fraction of Inhalable Aerosol) of any pneumatic jet nebulizer.
3D Animation of Circulaire II in Operation
The computerized animation demonstrates how the Circulaire II operates and why it has superior performance. During the exhalation phase, exhaled air (yellow) holds the one-way flapper valve shut and directs the exhalation out through the filter and the variable expiratory resistor. Meanwhile, the nebulizer, which is operating continuously, inflates the reservoir bag with its aerosol output.
When the subsequent inhalation begins, the patient inhales and receives aerosol from BOTH the nebulizer and the reservoir bag (light blue).
Consequently, there is little or no room air entrainment to dilute the inspired aerosol. Because the patient receives aerosol from two sources simultaneously (nebulizer plus reservoir), the inhaled mass of drug to the patient is approximately double what the patient would receive from any other non-reservoir device.
Understanding this set of repetitive steps that occur during inhalation and exhalation within the Circulaire system, as depicted in the animation above, is key to appreciating how the device is able to perform so much better than all other disposable jet nebulizers.
Circulaire II Features and Benefits
The Circulaire II system has many features and benefits ranging from enhanced drug delivery, to an integral expiratory filter to protect healthcare workers, to the ability to easily add Positive Expiratory Pressure (PEP) to the treatment to simultaneously take advantage of its physiologic benefits on gas exchange, aerosol distribution and deposition and airway clearance.
The Circulaire II Brochure provides an overview of the Circulaire II High-Efficiency Aerosol Drug Delivery System, the components parts, and the basic ordering configurations.
Circulaire II Hybrid for Home Care Also Available
For more in-depth technical information, including in vitro studies, please see the Technical and Educational Resources section below.
Technical & Educational Resources
“Understanding the Hess Paper.” This Westmed Clinical Education Bulletin dissects the classic Hess and colleagues paper wherein they compare functional performance of 17 different small volume nebulizers and determine that the Westmed VixOne is a top performer.
Download, PDF, 5 Mb.
Gardenhire D, “An In Vitro Comparison of Dosimetric and Constant Output Nebulizers VixOne versus AeroEclipse” (Respir Care 2007). This bench study documents that the VixOne nebulizer outperforms the AeroEclipse II nebulizer in both continuous mode and breath actuated mode with respect to inhaled mass, and shows that there is no statistically significant different between the two devices.
Download, PDF, 102 Kb.
Dennis J, Test Report, “Circulaire II vs AeroEclipse II BAN” (SolAeroMed 2009). This bench study using the European Nebulizer Standards methodology demonstrates greater aerosol output and shorter delivery times for the VixOne nebulizer when compared to the AeroEclipse nebulizer at two different breathing patterns.
Download, PDF 435 Kb.
McPeck M, “In Vitro Inhaled Aerosol Comparison of a Conserver Nebulizer (Circulaire II) vs a Breath Actuated nebulizer (AeroEclipse II)” (Respir Care 2010). This bench study demonstrated that the Circulaire II outperforms the AeroEclipse II with respect to greater Inhaled Mass and shorter treatment times measured during 4 different breathing patterns.
Download, PDF, 817 Kb.
McPeck M, “Financial Impact Spreadsheet AARC” (Respir Care 2010). This spreadsheet analysis demonstrates how the treatment time savings of the Circulaire II can be applied on a larger scale to achieve significant department time savings during different treatment scenarios and against other common nebulizers.
Download, PDF, 1.8 Mb.
Gardenhire D, “In Vitro Comparison of Dosimetric Nebulizers” (Am J Respir Crit Care Med 2011). This bench study demonstrates that the Circulaire II outperforms the AeroEclipse II and delivers 53% more medication over a 5 minute treatment. These results were statistically significant.
Download, PDF, 408 Kb.
Gardenhire D, “Circulaire II Hybrid with 6 Different Air Compressors” (Abstract for AARC Open Forum 2013). Optimal function of an SVN is dependent on proper driving pressure and flow, which apparently cannot be uniformly achieved by some air compressor and nebulizer combinations. The conserving effect of the Circulaire II Hybrid appears to compensate for marginally performing home air compressors and outperforms other SVNs tested. The Circulaire II Hybrid delivered from 1.6 to 2.8 times more medication than other nebulizers operated with the same air compressors, which was statistically significant.
Download, PDF, 164 Kb.
Gardenhire D, “Circulaire II Hybrid with 6 Different Air Compressors” (Poster at North American Cystic Fibrosis Conference, 2013). Optimal function of an SVN is dependent on proper driving pressure and flow, which apparently cannot be uniformly achieved by some air compressor and nebulizer combinations. The conserving effect of the Circulaire II Hybrid appears to compensate for marginally performing home air compressors and outperforms other SVNs tested. The Circulaire II Hybrid delivered from 1.6 to 2.8 times more medication than other nebulizers operated with the same air compressors, which was statistically significant.
Download, PDF, 1.7 Mb.
Grzeskowiak M, “Evaluation of the Circulaire II Aerosol Drug Delivery System for Microbiological Contamination” (Abstract for AARC Open Forum 2013). Abstract of a clinical study, submitted to AARC 2013 Open Forum, in which Circulaire II and Circulaire II Hybrid nebulizers and reservoirs were cultured daily for up to 4 consecutive days while in use. The study concluded that, despite using minimal post-treatment practices, in 252 cultures, no significant organism growth was found in either the nebulizer or reservoir of the Circulaire II devices. These findings suggest that the valved conserver device may isolate the nebulizer and reservoir and protect them from contamination.
Download, PDF, 77 Kb.
Grzeskowiak M, “Evaluation of the Circulaire II Aerosol Drug Delivery System for Microbiological Contamination” (Poster at AARC Open Forum 2013).
Download, PDF, 2.9 Mb.
“Protect the Patient; Protect the Caregiver with Circulaire.” This Westmed Clinical Education Bulletin reminds practitioners of the risks of aerosol therapy and discusses a recent study that proved that the Circulaire II system, with its unique “flapper valve” actually protects the nebulizer and the aerosol reservoir from becoming contaminated by exhaled patient droplets contained microorganisms. In addition, the CEB also discusses the importance of the integral exhalation filter in preventing exposure of healthcare workers to inhalable airborne medication particles and exhaled patient droplets that could cause illness, infection or untoward medication reactions.
Download, PDF, 358 Kb.
Grzeskowiak, “Adding Value to Aerosol Therapy.” (RT Magazine, March 2014).
Download, PDF, 2.4 Mb.
Please be sure your speakers are turned on. Press ▶︎ to play.