<i>β</i>Agonist Delivery by High-Flow Nasal Cannula During COPD Exacerbation

Beuvon, C.; Coudroy, Rémi; Bardin, J. L.; Marjanovic, Nicolas; Rault, Christophe; Bironneau, Vanessa; Drouot, Xavier; Robert, René; Thille, Arnaud W.; Frat, Jean‐Pierre

doi:10.4187/respcare.09242

Cited by 10 publications

(9 citation statements)

References 41 publications

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“…24 In our study, the usual criteria for reversibility (ie, 12% increase and/or 200 mL) were not reached. Our data are similar to those reported by Beuvon et al, 25 in which they performed bronchodilation with salbutamol via a vibrating mesh nebulizer in line with an HFNC, FEV 1 showed changes of 9.5% in their study population. Our study showed 13.7% changes in FEV 1 in a population with mostly severe (GOLD IV) COPD.…”

Section: Discussionsupporting

confidence: 92%

“…28,29 Of note, those 3 studies also made use of an HFNC system with a vibrating mesh nebulizer, and the temperature, flow, and cannula size used were the same as that described herein. 12,22,25 We reported increased FVC after bronchodilator nebulization, which could be considered a consequence of a reduction in lung hyperinflation. 30,31 In fact, there is a certain group of patients in whom bronchodilation can induce changes in FVC rather than FEV 1 .…”

Section: Discussionmentioning

confidence: 92%

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Delivery of Aerosolized Bronchodilators by High-Flow Nasal Cannula During COPD Exacerbation

et al. 2023

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BACKGROUND: Bronchodilator delivery via a high-flow nasal cannula (HFNC) has generated great interest in recent years. The efficacy of in-line vibrating mesh nebulizers with an HFNC during COPD exacerbation is limited. The aim of this study was to evaluate the clinical response of subjects with COPD exacerbation who require bronchodilator therapy (anticholinergic and b-agonist) by using a vibrating mesh nebulizer in line with an HFNC. METHODS: This was a prospective single-center study performed in a respiratory intermediate care unit that enrolled patients with a diagnosis of COPD exacerbation who required noninvasive ventilation on admission. All the subjects underwent noninvasive ventilation breaks with an HFNC. After clinical stability, pulmonary function tests were performed to assess changes in FEV 1 and clinical parameters before and after bronchodilation by using a vibrating mesh nebulizer in line with an HFNC. RESULTS: Forty-six patients with COPD exacerbation were admitted. Five patients who did not use noninvasive ventilation and 10 patients who did not receive bronchodilator treatment with a vibrating mesh nebulizer were excluded. Thirty-one were selected, but 1 subject was secondarily excluded due to loss of data. Finally, 30 subjects were included. The primary outcome was spirometric changes in FEV 1 . The mean 6 SD FEV 1 before receiving bronchodilator treatment by using a vibrating mesh nebulizer in line with an HFNC was 0.74 6 0.10 L, and, after receiving treatment, the mean 6 SD FEV 1 changed to 0.88 6 0.12 L (P < .001). Similarly, the mean 6 SD FVC increased from 1.75 6 0.54 L to 2.13 6 0.63 L (P < .001). Considerable differences were observed in breathing frequency and heart rate after receiving bronchodilator treatment. No relevant changes were observed in the Borg scale or S pO 2 after treatment. The mean clinical stability recorded was 4 d. CONCLUSIONS: In the subjects with COPD exacerbation, bronchodilator treatment by using a vibrating mesh nebulizer in line with an HFNC showed a mild but significant improvement in FEV 1 and FVC. In addition, a decrease in breathing frequency was observed, which suggests a reduction in loads imposed by dynamic hyperinflation.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 92%

Delivery of Aerosolized Bronchodilators by High-Flow Nasal Cannula During COPD Exacerbation

et al. 2023

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“…[1][2][3][4] In-line placement of a nebulizer with HFNC has been employed to deliver aerosolized medications, 5 such as inhaled epoprostenol for patients with pulmonary hypertension or refractory hypoxemia, 6,7 or inhaled albuterol for patients with asthma 8 or chronic obstructive diseases. 9,10 HFNC has been shown to be advantageous for nebulized therapy, compared to conventional aerosol delivery methods including nebulizers with facemask/mouthpiece, pressurized metered-dose inhalers (pMDIs), or dry powder inhalers (DPIs). 11 The nasal interface is more tolerable than a facemask or mouthpiece because it does not interfere with talking, eating, and drinking.…”

Section: Introductionmentioning

confidence: 99%

Mitigating Fugitive Aerosols During Aerosol Delivery via High-Flow Nasal Cannula Devices

Alolaiwat

Harnois

et al. 2021

Respir Care

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Background: Aerosol delivery via high-flow nasal cannula (HFNC) has attracted clinical interests in recent years. However, both HFNC and nebulization are categorized as aerosol generating procedures (AGPs). In-vitro studies raised concerns that AGPs had high transmission risk. Very few in-vivo studies examined fugitive aerosols with HFNC and nebulization via HFNC, and effective methods to mitigate aerosol dispersion are unknown.Method: Two HFNC devices (Airvo2 and Vapotherm) with or without a vibrating mesh nebulizer (VMN) were compared; HFNC alone, surgical mask over HFNC interface, and HFNC with face tent scavenger were used in a random order for nine healthy volunteers. Fugitive aerosol concentrations at sizes of 0.3-10 μm were continuously measured by particle sizers placed at one and three feet from participants. On a different day, six of the nine participants received six additional nebulizer treatments via VMN or small volume nebulizer (SVN) with mouthpiece with/without an expiratory filter or facemask. In-vitro simulation was employed to quantify inhaled dose with VMN via Airvo2 and Vapotherm.Results: Compared to baseline, neither HFNC device generated higher aerosol concentrations.Compared to HFNC alone, VMN via Airvo2 generated higher 0.3-1.0 μm particles (all p<.05) but VMN via Vapotherm did not. Concentrations of 1.0-3.0 μm particles with VMN via Airvo2 were similar with VMN and a mouthpiece/facemask but lower than SVN with a mouthpiece/facemask (all p<.05). Placing a surgical mask over HFNC during nebulization reduced 0.5-1.0 μm particles (all p<.05) to levels similar to the use of a nebulizer with mouthpiece and expiratory filter. In-vitro the inhaled dose with VMN via Airvo2 was 6 times higher than VMN via Vapotherm.

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“… 87 In a physiological crossover study including patients with severe acute exacerbation of COPD, we showed significantly improved FEV 1 (9%), FVC (14%) and PEF (20%) after salbutamol vibrating-mesh nebulization through HFNC as compared to HFNC alone, a finding suggesting an effective bronchodilator effect. 89 …”

Section: Acute-on-chronic Respiratory Failurementioning

confidence: 99%

Noninvasive Oxygenation in Patients with Acute Respiratory Failure: Current Perspectives

Frat¹,

Pape²,

Coudroy³

et al. 2022

IJGM

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Purpose of Review High-flow nasal oxygen and noninvasive ventilation are two alternative strategies to standard oxygen in the management of acute respiratory failure. Discussion Although high-flow nasal oxygen has gained major popularity in ICUs due to its simplicity of application, good comfort for patients, efficiency in improving oxygenation and promising results in patients with acute hypoxemic respiratory failure, further large clinical trials are needed to confirm its superiority over standard oxygen. Non-invasive ventilation may have deleterious effects, especially in patients exerting strong inspiratory efforts, and no current recommendations support its use in this setting. Protective non-invasive ventilation using higher levels of positive-end expiratory pressure, more prolonged sessions and other interfaces such as the helmet may have beneficial physiological effects leading to it being proposed as alternative to high-flow nasal oxygen in acute hypoxemic respiratory failure. By contrast, non-invasive ventilation is the first-line strategy of oxygenation in patients with acute exacerbation of chronic lung disease, while high-flow nasal oxygen could be an alternative to non-invasive ventilation after partial reversal of respiratory acidosis. Questions remain about the target populations and non-invasive oxygen strategy representing the best alternative to standard oxygen in acute hypoxemic respiratory failure. As concerns acute on-chronic-respiratory failure, the place of high-flow nasal oxygen remains to be evaluated.

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βAgonist Delivery by High-Flow Nasal Cannula During COPD Exacerbation

Cited by 10 publications

References 41 publications

Delivery of Aerosolized Bronchodilators by High-Flow Nasal Cannula During COPD Exacerbation

Delivery of Aerosolized Bronchodilators by High-Flow Nasal Cannula During COPD Exacerbation

Mitigating Fugitive Aerosols During Aerosol Delivery via High-Flow Nasal Cannula Devices

Noninvasive Oxygenation in Patients with Acute Respiratory Failure: Current Perspectives

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