Aerosol Delivery Through an Adult High-Flow Nasal Cannula Circuit Using Low-Flow Oxygen

Madney, Yasmin M.; Fathy, Mona; Elberry, Ahmed A.; Rabea, Hoda; Abdelrahim, Mohamed

doi:10.4187/respcare.06345

Cited by 50 publications

(69 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Incorporation of nebulizers into HFNC delivery systems has gained interest in recent years [2,3,4,5,6,7,8], for its combined benefits of comfort associated with nasal interface, trans-nasal pulmonary delivery of aerosolized medication, and mechanical benefits of HFNC. Aerosol with HFNC has been described with bronchodilators for asthmatic [2], bronchiolitis [3,4], or chronic obstructive pulmonary disease (COPD) patients [5,6,7], and inhaled epoprostenol for patients with pulmonary hypertension or hypoxemia [8]. Interruption of HFNC for administration of standard aerosol treatment for periods up to 15 min may compromise oxygenation, and administration by mouth, while receiving HFNC reduces the inhaled dose.…”

Section: Introductionmentioning

confidence: 99%

The Ratio of Nasal Cannula Gas Flow to Patient Inspiratory Flow on Trans-nasal Pulmonary Aerosol Delivery for Adults: An in Vitro Study

Gong

Fink

2019

Pharmaceutics

View full text Add to dashboard Cite

Trans-nasal aerosol deposition during distressed breathing is higher than quiet breathing, and decreases as administered gas flow increases. We hypothesize that inhaled dose is related to the ratio of gas flow to patient inspiratory flow (GF:IF). An adult manikin (Laerdal) with a collecting filter placed at trachea was connected to a dual-chamber model lung, which was driven by a ventilator to simulate quiet and distressed breathing with different inspiratory flows. Gas flow was set at 5, 10, 20, 40 and 60 L/min. Albuterol (2.5mg in 1 mL) was nebulized by vibrating mesh nebulizer at the inlet of humidifier at 37 °C for each condition (n = 3). Drug was eluted from the filter and assayed with UV spectrophotometry (276 nm). GF:IF was the primary predictor of inhaled dose (p < 0.001). When the ratio was < 1.0, the inhaled dose was higher than ratio > 1.0 (21.8 ± 3.8% vs. 9.0 ± 3.7%, p < 0.001), and the inhaled dose was similar between quiet and distressed breathing (22.3 ± 5.0% vs. 21.3 ± 2.7%, p = 0.379). During trans-nasal aerosol delivery, GF:IF primarily affected the inhaled dose. Compared to the ratio above 1.0, the ratio below 1.0 produced a higher and more-consistent inhaled dose.

show abstract

Section: Introductionmentioning

confidence: 99%

The Ratio of Nasal Cannula Gas Flow to Patient Inspiratory Flow on Trans-nasal Pulmonary Aerosol Delivery for Adults: An in Vitro Study

Gong

Fink

2019

Pharmaceutics

View full text Add to dashboard Cite

show abstract

“…[2,10] However, the highest patient tolerability and preference were reported with HFNC as only 8% of participants complained of this interface. [2,8,10] HMP and HFM showed approximately similar results of the ex-vivo total delivered dose and the recovered fractions of salbutamol from urine samples and were significantly higher than that of HFNC (p<0.05). Consequently, a better pulmonary deposition could be obtained with HMP and HFM interfaces.…”

Section: Discussionmentioning

confidence: 69%

Aerosol delivery aspects within a high-flow therapy system in COPD patients

et al. 2020

Self Cite

View full text Add to dashboard Cite

There is a lack of information about the influence of patient interfaces like facemask or mouthpiece on the effective dose of aerosolized drugs while using high flow therapy in a clinical setting. These interfaces can improve pulmonary drug delivery over nasal cannula but patient preference and comfort should also be considered.The present work was to determine the effect of three different interfaces (nasal cannula, valved face mask, and mouthpiece) when combined with titrated oxygen flow on aerosol delivery in chronic obstructive pulmonary disease (COPD) patients hospitalised due to acute exacerbation.The variations between these interfaces were addressed in terms of change in lung function measurements pre-and post-inhalation, the delivered salbutamol dose, and patient tolerance to each interface.High flow nasal cannula was the most comfortable interface used. However, its pulmonary drug delivery was significantly lower than both the valved face mask and mouthpiece (p<0.05). Although drug delivery was different with the three tested interfaces, the lung function improvements were similar.

show abstract

“…In a crossover RCT with 12 stable COPD patients, Madney and colleagues compared systemic bioavailability of albuterol administered by JN or VMN in line with HFNC at 5 L/min. Urinary albuterol excretion at 30 min and 24 h was 2-fold higher with the VMN than the JN ( p < 0.05) [ 11 ].…”

Section: Clinical Evidence Of Trans-nasal Aerosol Deliverymentioning

confidence: 99%

“…Additionally, the residual volume of drug remaining in nebulizers is higher in JN than VMN (45% vs 3%) [ 41 , 43 ]. Consequently, VMN generated 2–3 times higher inhaled dose than JN via HFNC for both pediatric and adult populations (Table 2 ) [ 11 , 33 , 38 , 41 ]. For these reasons, VMNs are preferred over JNs for aerosol delivery with HFNC [ 8 ].…”

Section: Factors Influencing Trans-nasal Aerosol Deliverymentioning

confidence: 99%

A narrative review on trans-nasal pulmonary aerosol delivery

Fink

MacLoughlin

et al. 2020

Crit Care

View full text Add to dashboard Cite

The use of trans-nasal pulmonary aerosol delivery via high-flow nasal cannula (HFNC) has expanded in recent years. However, various factors influencing aerosol delivery in this setting have not been precisely defined, and no consensus has emerged regarding the optimal techniques for aerosol delivery with HFNC. Based on a comprehensive literature search, we reviewed studies that assessed trans-nasal pulmonary aerosol delivery with HFNC by in vitro experiments, and in vivo, by radiolabeled, pharmacokinetic and pharmacodynamic studies. In these investigations, the type of nebulizer employed and its placement, carrier gas, the relationship between gas flow and patient’s inspiratory flow, aerosol delivery strategies (intermittent unit dose vs continuous administration by infusion pump), and open vs closed mouth breathing influenced aerosol delivery. The objective of this review was to provide rational recommendations for optimizing aerosol delivery with HFNC in various clinical settings.

show abstract

Aerosol Delivery Through an Adult High-Flow Nasal Cannula Circuit Using Low-Flow Oxygen

Cited by 50 publications

References 40 publications

The Ratio of Nasal Cannula Gas Flow to Patient Inspiratory Flow on Trans-nasal Pulmonary Aerosol Delivery for Adults: An in Vitro Study

The Ratio of Nasal Cannula Gas Flow to Patient Inspiratory Flow on Trans-nasal Pulmonary Aerosol Delivery for Adults: An in Vitro Study

Aerosol delivery aspects within a high-flow therapy system in COPD patients

A narrative review on trans-nasal pulmonary aerosol delivery

Contact Info

Product

Resources

About