Aerosol Delivery Through Adult High Flow Nasal Cannula With Heliox and Oxygen

Dailey, P. A.; Harwood, Robert; Walsh, Kyle M.; Fink, James B.; Thayer, Tina; Gagnon, Gregory; Ari, Arzu

doi:10.4187/respcare.05127

Cited by 46 publications

(68 citation statements)

References 15 publications

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“…Everard et al found approximately 50% reduction in lung deposition with nasal inhalation, which is consistent with the findings of this study. Aerosol drug delivery through HFNC has gained popularity over the years and the performance of HFNC on aerosol delivery has been investigated in previous research . Similar to previous evidence, we also found that decreasing flow rate with HFNC and LFNC increases aerosol drug delivery in infants and pediatrics because of a reduction in turbulent and transitional flow.…”

Section: Discussionsupporting

confidence: 88%

Effect of nebulizer type, delivery interface, and flow rate on aerosol drug delivery to spontaneously breathing pediatric and infant lung models

Ari

2019

Pediatric Pulmonology

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Background Different types of nebulizers, interfaces, and flow rates are used to deliver aerosolized medications to children. The purpose of this study was to determine the effect of nebulizer type, delivery interface, and flow rate on aerosol drug delivery to spontaneously breathing pediatric and infant lung models. Methodology A teaching mannequin was attached to a sinusoidal pump via a collecting filter at the bronchi to simulate a spontaneously breathing child (Vt: 250 mL, RR: 20 bpm and Ti: 1 second) and infant (Vt = 100 mL, RR = 30 bpm, Ti: 0.7 seconds). Albuterol sulfate was nebulized with jet (Misty Max 10; Cardinal Health) and mesh (Aerogen Solo; Aerogen) nebulizers using a low‐flow nasal cannula (LFNC; Hudson), a high‐flow nasal cannula (HFNC; Fisher & Paykel), face mask (FM; Hudson), and mouthpiece (MP; Cardinal Health). While all interfaces were used in the pediatric study, only LFNC, HFNC, and FM were tested in the infant study. The mesh nebulizer was tested at 2, 4, and 6 L/min with LFNC, 4 and 6 L/min with HFNC, and 6 L/min with FM and MP. The jet nebulizer was operated at 6 and 8 L/min with FM and 6 L/min with LFNC, HFNC, and MP (n = 5). The drug was eluted from the filter and analyzed by spectrophotometry. Factorial analysis of variance and post hoc comparisons were used for data analysis. P < .05 was considered statistically significant. Results Delivery efficiency of mesh nebulizers is two to fourfold more than jet nebulizers used with HFNC, FM, and MP. No statistical difference was found between jet and mesh nebulizers used with LFNC in infants (P = .643) and pediatrics (P = .255). Aerosol delivery with MP was the best compared to other interfaces used in pediatrics (P < .05). As the second‐best interface in aerosol drug delivery, the delivery efficiency of FM was greater than HFNC (P = .0001) and LFNC (P = .0001). Increasing flow rate with LFNC and HFNC decreased aerosol delivery with the mesh nebulizer in both infants and pediatrics. Conclusion The type of nebulizer, delivery interface, and flow rate used in the treatment of children affect aerosol drug delivery.

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Section: Discussionsupporting

confidence: 88%

Effect of nebulizer type, delivery interface, and flow rate on aerosol drug delivery to spontaneously breathing pediatric and infant lung models

Ari

2019

Pediatric Pulmonology

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“…During simulated paediatric breathing, 1.2, 0.1 and 0% were found for gas-flow rates of 3, 10 and 20 L/min, as compared to this study's findings of 3.23 ± 1.58, 0.42 ± 0.06 and 1.17 ± 0.28% for flow rates of 2, 10 and 20 L/min. Dailey et al [36] examined the inhaled dose using a high-flow nasal cannula and reported considerably higher values of 26.7% to 27.4% at 10 L/min, 11.6% to 14.2% at 30 L/min and 3.5% to 5.9% at 50 L/min. Perry et al [13] used a lower tidal volume for the paediatric breathing profiles setting than the present study; while Dailey et al used an inspiratory-expiratory ratio of 1:2, an Albuterol sulphate mixture (2.5 mg/0.5 mL).…”

Section: Discussionmentioning

confidence: 99%

“…This indicated that the majority of the loss mechanisms occurred prior to exiting the patient interface. Dailey et al [36] reported that increased flow rate could increase turbulence and impactive loss of aerosol within the tubing, which means less aerosol is reaching the patient interface and available for inhalation and/or to be released as fugitive aerosol.…”

Section: Discussionmentioning

confidence: 99%

Investigation of Fugitive Aerosols Released into the Environment during High-Flow Therapy

et al. 2019

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Background: Nebulised medical aerosols are designed to deliver drugs to the lungs to aid in the treatment of respiratory diseases. However, an unintended consequence is the potential for fugitive emissions during patient treatment, which may pose a risk factor in both clinical and homecare settings. Methods: The current study examined the potential for fugitive emissions, using albuterol sulphate as a tracer aerosol during high-flow therapy. A nasal cannula was connected to a head model or alternatively, a interface was connected to a tracheostomy tube in combination with a simulated adult and paediatric breathing profile. Two aerodynamic particle sizers (APS) recorded time-series aerosol concentrations and size distributions at two different distances relative to the simulated patient. Results: The results showed that the quantity and characteristics of the fugitive emissions were influenced by the interface type, patient type and supplemental gas-flow rate. There was a trend in the adult scenarios; as the flow rate increased, the fugitive emissions and the mass median aerodynamic diameter (MMAD) of the aerosol both decreased. The fugitive emissions were comparable when using the adult breathing profiles for the nasal cannula and tracheostomy interfaces; however, there was a noticeable distinction between the two interfaces when compared for the paediatric breathing profiles. The highest recorded aerosol concentration was 0.370 ± 0.046 mg m−3 from the tracheostomy interface during simulated paediatric breathing with a gas-flow rate of 20 L/min. The averaged MMAD across all combinations ranged from 1.248 to 1.793 µm by the APS at a distance of 0.8 m away from the patient interface. Conclusions: Overall, the results highlight the potential for secondary inhalation of fugitive emissions released during simulated aerosol treatment with concurrent high-flow therapy. The findings will help in developing policy and best practice for risk mitigation from fugitive emissions.

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“…Conversely, Reminiac et al reported that the respirable mass of drug was significantly higher during simulated respiratory distress than simulated quiet breathing [22]. Dailey et al showed that with a distressed breathing pattern, aerosol delivery was greater at 30 and 50 LPM than with a quiet breathing pattern [33].…”

Section: Discussionmentioning

confidence: 99%

In Vitro Determination of the Main Effects in the Design of High-Flow Nasal Therapy Systems with Respect to Aerosol Performance

et al. 2018

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Introduction: The use of concurrent aerosol delivery during high-flow nasal therapy (HFNT) may be exploited to facilitate the delivery of a variety of prescribed medications for inhalation. Until now, a systematic approach to determine the conditions required to yield an optimal emitted dose has not been reported. The aim of this study was to establish the effects of gas flow rate, input droplet size, and nebulizer position on the amount of aerosol exiting the nasal cannula during HFNT and thus becoming available for inhalation. Methods: Testing was completed according to a factorial statistical design of experiments (DOE) approach. Emitted dose was characterized with a vibrating mesh nebulizer (Aerogen Solo, Aerogen Ltd) for an adult model of HFNT at three clinically relevant gas flow rates, using three nebulizers producing varying input droplet sizes and placed at two different nebulizer positions.

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Aerosol Delivery Through Adult High Flow Nasal Cannula With Heliox and Oxygen

Abstract: With a distressed breathing pattern, aerosol delivery was greater at 30 and 50 L/min than with a quiet breathing pattern. Trends toward higher inhaled dose with heliox during HFNC were not significant.

Cited by 46 publications

References 15 publications

Effect of nebulizer type, delivery interface, and flow rate on aerosol drug delivery to spontaneously breathing pediatric and infant lung models

Effect of nebulizer type, delivery interface, and flow rate on aerosol drug delivery to spontaneously breathing pediatric and infant lung models

Investigation of Fugitive Aerosols Released into the Environment during High-Flow Therapy

In Vitro Determination of the Main Effects in the Design of High-Flow Nasal Therapy Systems with Respect to Aerosol Performance

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