The Use of Condensational Growth Methods for Efficient Drug Delivery to the Lungs during Noninvasive Ventilation High Flow Therapy

Golshahi, Laleh; Tian, Geng; Azimi, Mandana; Son, Yoen-Ju; Walenga, Ross; Longest, P. Worth; Hindle, Michael

doi:10.1007/s11095-013-1123-3

Cited by 58 publications

(70 citation statements)

References 30 publications

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“…However, the effectiveness of this method has been controversial and has not been obvious in all applications. 20 In this study, we extend the previous work of Golshahi et al 13 and incorporate realistic breathing cycles into the in vitro testing to compare continuous aerosol drug delivery using controlled condensational growth methods (ECG and EEG) with 2 modes of intermittent aerosol delivery compared with continuous aerosol delivery.…”

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 96%

“…This technique has been evaluated for use with on-demand spray inhalers such as the Respimat 11 and with newly developed powder inhalers. 12 Golshahi et al 13 described the development and initial in vitro testing of an aerosol delivery setup to enable both ECG and EEG methods during HFNC therapy. Steadystate studies were performed using a constant inhalation flow to assess device deposition, NMT model deposition, and aerosol growth.…”

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 99%

“…The nasal cannulas were designed using a streamlining approach to minimize aerosol drug deposition by avoiding sharp edges, which may cause rapid change in the direction of aerosol stream and consequently impaction losses. 7 Golshahi et al 13 observed that, under steady inhalation flow conditions (without an exhalation cycle), for a 0.2% albuterol sulfate and 0.2% sodium chloride nebulized formulation, the mean drug doses delivered through the nasal cannula and the in vitro NMT model were 88.5% and 78% of the nominal dose using the EEG and ECG growth protocols, respectively. In addition, the particle size of the original submicrometer-sized particles when measured following passage through the NMT at the trachea was 1.55 m for EEG delivery and 2.82 m for ECG delivery.…”

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 99%

“…In addition, the particle size of the original submicrometer-sized particles when measured following passage through the NMT at the trachea was 1.55 m for EEG delivery and 2.82 m for ECG delivery. Golshahi et al 13 demonstrated the feasibility of delivering a submicrometer aerosol during HFNC therapy with minimal deposition in both the delivery device and the nasal passages. However, this study was performed using steady-state inhalation flow without an exhalation cycle.…”

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 99%

“…For ECG delivery, ventilation gas (20 L/min) was again supplied to the mixer-heater, and a separate stream of HFNC therapy flow (15 L/min, 43°C, relative humidity Ͼ 95%) was delivered to the gas inlet of a divided cannula. The components of the aerosol mixer-heater system and in vitro test setup are shown schematically in Figure 1A and have been described previously 13 with the following modifications. First, a breathing simulator (ASL 5000, Ingmar Medical, Pittsburgh, Pennsylvania) was incorporated into the in vitro model to produce realistic breathing profiles during aerosol generation.…”

Section: Aerosol Mixer-heater System and In Vitro Nasal Delivery Setupmentioning

confidence: 99%

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Intermittent Aerosol Delivery to the Lungs During High-Flow Nasal Cannula Therapy

Golshahi¹,

Longest²,

Azimi³

et al. 2014

Respir Care

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INTRODUCTION:Use of submicrometer particles combined with condensational growth techniques has been proposed to reduce drug losses within components of high-flow nasal cannula therapy systems and to enhance the dose reaching the lower respiratory tract. These methods have been evaluated using continuous inhalation flow rather than realistic inhalation/exhalation breathing cycles. The goal of this study was to evaluate in vitro aerosol drug delivery using condensational growth techniques during high-flow nasal cannula therapy using realistic breathing profiles and incorporating intermittent aerosol delivery techniques. METHODS: A mixer-heater combined with a vibrating mesh nebulizer was used to generate a submicrometer aerosol using a formulation of 0.2% albuterol sulfate and 0.2% sodium chloride in water. Delivery efficiency of the aerosol for 1 min through a nasal cannula was considered using an intermittent delivery regime with aerosol being emitted for either the entire inhalation time (2 s) or half of the inhalation period (1 s) and compared with continuous delivery. The deposition of the aerosol was evaluated in the nasal delivery components (ventilator tubing and cannula) and an in vitro adult nose-mouth-throat (NMT) model using 3 realistic breathing profiles. RESULTS: Significant improvements in dose delivered to the exit of the NMT model (ex-NMT) were observed for both condensational growth methods using intermittent aerosol delivery compared with continuous delivery, and increasing the tidal volume was found useful. The combination of the largest tidal volume with the shortest intermittent delivery time resulted in the lowest respiration losses and the highest ex-NMT delivered dose. CONCLUSIONS: Intermittent aerosol delivery using realistic breathing profiles of submicrometer condensational growth aerosols was found to be efficient in delivering nasally administered drugs in an in vitro airway model.

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Section: What This Paper Contributes To Our Knowledgementioning

confidence: 96%

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 99%

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 99%

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 99%

Section: Aerosol Mixer-heater System and In Vitro Nasal Delivery Setupmentioning

confidence: 99%

See 3 more Smart Citations

Intermittent Aerosol Delivery to the Lungs During High-Flow Nasal Cannula Therapy

Golshahi¹,

Longest²,

Azimi³

et al. 2014

Respir Care

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Aerosol Therapies During High Flow Oxygen Therapy

Abdelrahim

Saeed

Harb

et al. 2021

Essentials of Aerosol Therapy in Critically Ill Patients

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Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review

et al. 2016

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Oxygen therapy can be delivered using low-flow, intermediate-flow (air entrainment mask), or high-flow devices. Low/intermediate-flow oxygen devices have several drawbacks that cause critically ill patients discomfort and translate into suboptimal clinical results. These include limitation of the FiO2 (due to the high inspiratory flow often observed in patients with respiratory failure), and insufficient humidification and warming of the inspired gas. High-flow nasal cannula oxygenation (HFNCO) delivers oxygen flow rates of up to 60 L/min and over the last decade its effect on clinical outcomes has widely been evaluated, such as in the improvement of respiratory distress, the need for intubation, and mortality. Mechanisms of action of HFNCO are complex and not limited to the increased oxygen flow rate. The main aim of this review is to guide clinicians towards evidence-based clinical practice guidelines. It summarizes current knowledge about HFNCO use in ICU patients and the potential areas of uncertainties. For instance, it has been recently suggested that HFNCO could improve the outcome of patients with hypoxemic acute respiratory failure. In other settings, research is ongoing and additional evidence is needed. For instance, if intubation is required, studies suggest that HFNCO may help to improve preoxygenation and can be used after extubation. Likewise, HFNCO might be used in obese patients, or to prevent respiratory deterioration in hypoxemic patients requiring bronchoscopy, or for the delivery of aerosol therapy. However, areas for which conclusive data exist are limited and interventions using standardized HFNCO protocols, comparators, and relevant clinical outcomes are warranted.

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The Use of Condensational Growth Methods for Efficient Drug Delivery to the Lungs during Noninvasive Ventilation High Flow Therapy

Cited by 58 publications

References 30 publications

Intermittent Aerosol Delivery to the Lungs During High-Flow Nasal Cannula Therapy

Intermittent Aerosol Delivery to the Lungs During High-Flow Nasal Cannula Therapy

Aerosol Therapies During High Flow Oxygen Therapy

Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review

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