The influence of changing interfaces on aerosol delivery within high flow oxygen setting in adults: An in-vitro study

Madney, Yasmin M.; Laz, Nabila Ibrahim; Elberry, Ahmed A.; Rabea, Hoda; Abdelrahim, Mohamed

doi:10.1016/j.jddst.2019.101365

Cited by 40 publications

(71 citation statements)

References 59 publications

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“…In the case of facemask interface, a plate was added to the experimental setup and the facemask was sealed to it as shown in figure 2c. This plating method was previously shown to have no significant difference to the face method for the determination of the inhalable mass from different aerosol generators with facemask [18,25,26]. The emitted dose from the MDI and MDI+add-on device was measured by collecting one individual dose at 28.3 L•min −1 with an inhaled volume of 4, 2 and 1 L. 10 determinations were made for each dose emission (n=10).…”

Section: Methodsmentioning

confidence: 99%

Comparison between traditional and nontraditional add-on devices used with pressurised metered-dose inhalers

et al. 2020

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Add-on devices that are attached to metered-dose inhalers (MDIs) were introduced to improve aerosol delivery. The objective of this study was to determine the efficacy of drug delivery from an MDI when attached to different add-on devices at different inhalation volumes.The total emitted dose (TED) of salbutamol was estimated for the MDI alone and the MDI connected to five different add-on devices (Able valved holding chamber, Tips-haler valved holding chamber, Aerochamber plus flow Vu valved holding chamber, Dolphin chamber, and a handmade water bottle spacer), at inhalation flow of 28.3 L·min−1 with flow volume of 1, 2 and 4 L, assuming young child (aged <6 years), old child (>6 years) and adult inhalation volumes, respectively.The TED% ranged between 84.1% and 87.2% at all inhalation volumes from the MDI alone, which was significantly greater than all MDI add-on device combinations (p<0.05). The TED% delivered to MDI sampling apparatus by a homemade water bottle spacer and Dolphin chamber, as non-antistatic add-on devices, ranged between 30.5% and 35.3%. However, washing these non-antistatic add-on devices with a light detergent before use improved their TED to range between 47.6% and 51.2%. Non-antistatic add-on devices had significantly lower TED (p<0.05) than that delivered by most antistatic add-on devices, which ranged from 51.3% to 71.6%.This study suggests that antistatic add-on devices delivered much more aerosol than non-antistatic add-on devices. However, it may be advised to still use a non-antistatic add-on device, for the sake of solving the coordination problem, and wash it with light detergent before use to improve TED.

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Section: Methodsmentioning

confidence: 99%

Comparison between traditional and nontraditional add-on devices used with pressurised metered-dose inhalers

et al. 2020

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“…[2] The use of patient interfaces like facemask or mouthpiece over nasal cannula within a high flow system can improve pulmonary drug delivery but patient preference would be affected. [3,4] The present work was to determine the effect of three different interfaces on aerosol delivery when combined with titrated oxygen flow within a high flow system in chronic obstructive pulmonary disease (COPD) patients. The variations were addressed between these interfaces in terms of change in lung function measurements pre and post-inhalation, the delivered salbutamol dose, and patient tolerance to each interface.…”

Section: Introductionmentioning

confidence: 99%

“…Inhaling an aerosol through a nasal cannula creates turbulence and increases aerosol loss within the nasopharynx [ 2 ]. The use of patient interfaces such as a facemask or mouthpiece over a nasal cannula within a high-flow system can improve pulmonary drug delivery, but patient preference would be affected [ 3 , 4 ]. The present work was to determine the effect of three different interfaces on aerosol delivery when combined with titrated oxygen flow within a high-flow system in patients with COPD.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…4 Over the past decades, attempts to combine aerosol delivery with noninvasive ventilation are largely appreciated to maximise patient benefits. 3,[5][6][7][8][9][10][11][12][13] One of the well-studied systems for delivering noninvasive respiratory support is a high flow oxygen system that can deliver heated-humidified gas inflows up to 60 L/min but one can wonder whether the high flow is generally beneficial to patients in all cases. 14,15 Uncontrolled oxygen therapy in acutely exacerbated COPD patients can result in an increased risk of severe respiratory acidosis and mortality.…”

Section: Introductionmentioning

confidence: 99%

The impact of changing patient interfaces on delivering aerosol with titrated oxygen in the high flow system

et al. 2020

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Introduction Despite the widespread oxygen‐culture as more is better in prehospital and hospital settings, the use of titrated oxygen‐flow within a high‐flow system can be beneficial especially when combined with aerosol‐delivery and also save the patient from unnecessary‐hyperoxia. Methods Forty‐five COPD patients were included in this study where they allocated in three‐groups (nasal‐delivery, oral‐delivery, and oronasal‐delivery groups). All patients were received their inhaled‐salbutamol dose using Aerogen Solo nebuliser by one of the three interfaces, eg, nasal‐cannula, mouthpiece, and facemask in two conditions; with oxygen‐flow and without any oxygen‐flow. Pulmonary and systemic salbutamol deposition was estimated by collecting two urine‐samples from the patient; 30 min post‐inhalation and cumulatively 24 hr post‐inhalation. The quantity of salbutamol in these collected samples was measured by high‐performance liquid chromatography. Lung function measurement was performed pre‐bronchodilator inhalation and 30 min post‐bronchodilator to estimate the change in pulmonary functions post‐inhalation regarding all tested interfaces. Results COPD patients showed the highest salbutamol percentage excreted 30 min post‐inhalation of 5.7% (1.4) with mouthpiece interface when combined with oxygen at P < .002. While with the same condition using oxygen, valved‐facemask showed the highest salbutamol percentage excreted in 24 hr post inhalation samples but the difference is only significantly compared with nasal cannula (P < .006). Moreover, without oxygen delivery, mouthpiece and valved facemask showed approximately the same salbutamol percentage excreted in 30 min post‐inhalation samples, higher than that delivered by nasal cannula (P < .001). Of note, salbutamol delivery is significantly increased with oxygen flow for all interfaces (P < .05) except with nasal cannula. Conclusions The nasal cannula is a more comfortable and tolerable interface despite the lower fraction of the delivered drug compared with other tested interfaces. The use of oxygen‐flow with aerosol delivery within a high flow system positively affects the delivered drug fraction and the pulmonary deposition of the drug.

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The influence of changing interfaces on aerosol delivery within high flow oxygen setting in adults: An in-vitro study

Cited by 40 publications

References 59 publications

Comparison between traditional and nontraditional add-on devices used with pressurised metered-dose inhalers

Comparison between traditional and nontraditional add-on devices used with pressurised metered-dose inhalers

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

The impact of changing patient interfaces on delivering aerosol with titrated oxygen in the high flow system

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