Aerosol Therapy in Adults Receiving High Flow Nasal Cannula Oxygen Therapy

Réminiac, François; Vecellio, Laurent; Heuzé-Vourc’h, Nathalie; Petitcollin, Antoine; Respaud, Renaud; Cabrera, Montserrat; Pennec, Déborah Le; Diot, Patrice; Ehrmann, Stéphan

doi:10.1089/jamp.2015.1219

Cited by 88 publications

(169 citation statements)

References 36 publications

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“…Sweeney et al showed that the mean tracheal dose during simulated HFNT in vitro is significantly lower for a cystic fibrosis breathing profile than for normal adult breathing [32]. 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%

“…Similarly, Perry et al reported that the in vitro inspired dose during HFNT decreased from 2.5% to 0.2% upon increasing the flow rate from 5 to 40 LPM [15]. Reminiac et al also showed reductions in inhaled dose with increasing gas flow rate [22].…”

Section: Influence Of Flow Rate On Emitted Dosementioning

confidence: 90%

“…Nebulizers were attached before the humidification chamber, after the humidification chamber, or at the distal position immediately upstream from the nasal cannula. Reminiac and colleagues showed that when using the Aerogen-mesh nebulizer, the inhalable mass was significantly lower at the distal position immediately upstream of the cannula [22].…”

Section: Influence Of Nebulizer Position On Emitted Dosementioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Influence Of Flow Rate On Emitted Dosementioning

confidence: 90%

Section: Influence Of Nebulizer Position On Emitted Dosementioning

confidence: 99%

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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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“…beta agonists) continuously and without changing the interface [30–32, 49, 50] as during NIV. Recent studies suggest greater efficacy of vibrating mesh nebulizers over jet nebulizers [30, 31]. The former was used in association with NHF, and a jet nebulizer was used for children treated with standard oxygen, which further complicates interpretation of the results.…”

Section: Discussionmentioning

confidence: 99%

Nasal high flow in management of children with status asthmaticus: a retrospective observational study

Baudin

Buisson

Vanel

et al. 2017

Ann. Intensive Care

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BackgroundAsthma is the most common obstructive airway disease in children and adults. Nasal high flow (NHF) is a recent device that is now used as a primary support for respiratory distress. Several studies have reported use of NHF as a respiratory support in status asthmaticus; however, there are no data to recommend such practice. We therefore conducted this preliminary study to evaluate NHF therapy for children with status asthmaticus admitted to our PICU in order to prepare a multicentre randomized controlled study.ResultsBetween November 2009 and January 2014, 73 patients with status asthmaticus were admitted to the PICU, of whom 39 (53%) were treated with NHF and among these 10 (26%) presented severe acidosis at admission (pH < 7.30). Thirty-four less severe children (41%) were treated with standard oxygen. For one child (2.6%) NHF failed and was then switched to non-invasive ventilation. NHF was discontinued in another patient because of the occurrence of pneumothorax after 31 h with NHF; the patient was then switched to standard oxygen therapy. Mean ± SD heart rate (165 ± 21 vs. 141 ± 25/min, p < 0.01) and respiratory rate (40 ± 13 vs. 31 ± 8/min, p < 0.01) decreased significantly, and blood gas improved in the first 24 h. In the subgroup of patients with acidosis, median [IQR] pH increased significantly between hour 0 and 2 (7.25 [7.21–7.26] vs. 7.30 [7.27–7.33], p = 0.009) and median [IQR] pCO2 decreased significantly (7.27 kPa [6.84–7.91 vs. 5.85 kPa [5.56–6.11], p = 0.007). No patient was intubated.ConclusionThis retrospective study showed the feasibility and safety of NHF in children with severe asthma. Blood gas and clinical parameters were significantly improved during the first 24 h. NHF failed in only two patients, and none required invasive ventilation.

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“…It has been suggested that placement of nebulizers prior to humidifier can improve drug delivery distal to artificial airway in mechanically ventilated adult and pediatric patients in presence of bias flow, [4][5][6] patients receiving gas via high flow nasal cannula (HFNC), [7,8] as well as infants receiving nasal continuous positive airway pressure (nCPAP) and synchronized inspiratory positive airway pressure (Si PAP) [9]. While placement of aerosol generator at inlet of humidifier has been shown to improve aerosol delivery efficiency from range of nebulizers, it is not known whether aerosolized drug that rains out into the heated humidifier could result in undesirable drugs changes that could have undesirable effect on patient.…”

Section: Introductionmentioning

confidence: 99%

Stability of commonly nebulized drugs in heated and humid condition

Saeed¹,

Abdelrahim²,

Fink³

2018

Med-Science

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Placement of nebulizer prior to heated humidifier has been reported to improve efficiency of aerosol delivery during ventilator support. Drugs nebulized in this position must travel through humidifier, rainout in reservoir and may be subjected to extended periods of heat up to 50°C. Toxic degradation may develop, posing potential risk to patient. The aim of this study was to evaluate chemical stability of commonly inhaled drugs administered to mechanically ventilated patients subjected to extended period of 50°C. Formulations of 8 comonly inhaled drugs were diluted to 50 mL total volume in water and exposed to 50oC for 7 days to simulate effect of heat in humidifier. High Performance Liquid Chromatography (HPLC) was performed before and after heating to determine drug stability and degradation. Drug integrity, color or pH changes were noted. Epinephrine, levalbuterol, tobramycin and colistin demonstrated>10% reduction in concentration but only acetylcysteine had additional peaks in HPLC chromatogram demonstrating potential degradation and possible production of by product. Changes in color were observed with epinephrine and acetylcysteine. All drugs retained their integrity after subjecting them to 50oC for 7 days except acetylcysteine. Acetylcysteine changed color and had new peak in HPLC chromatogram. Color change with epinephrine was not associated with any new peak in HPLC chromatogram. Further studies should determine whether acetylcysteine changes would result in any off gassing of vapor that might harm the patient.

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Aerosol Therapy in Adults Receiving High Flow Nasal Cannula Oxygen Therapy

Cited by 88 publications

References 36 publications

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

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

Nasal high flow in management of children with status asthmaticus: a retrospective observational study

Stability of commonly nebulized drugs in heated and humid condition

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