Nasal high-flow bronchodilator nebulization: a randomized cross-over study

Abstract

BackgroundThere is an absence of controlled clinical data showing bronchodilation effectiveness after nebulization via nasal high-flow therapy circuits.ResultsTwenty-five patients with reversible airflow obstruction received, in a randomized order: (1) 2.5 mg albuterol delivered via a jet nebulizer with a facial mask; (2) 2.5 mg albuterol delivered via a vibrating mesh nebulizer placed downstream of a nasal high-flow humidification chamber (30 L/min and 37 °C); and (3) nasal high-flow therapy without nebulization. All three conditions induced significant individual increases in forced expiratory volume in one second (FEV1) compared to baseline. The median change was similar after facial mask nebulization [+ 350 mL (+ 180; + 550); + 18% (+ 8; + 30)] and nasal high flow with nebulization [+ 330 mL (+ 140; + 390); + 16% (+ 5; + 24)], p = 0.11. However, it was significantly lower after nasal high-flow therapy without nebulization [+ 50 mL (− 10; + 220); + 3% (− 1; + 8)], p = 0.0009. FEV1 increases after facial mask and nasal high-flow nebulization as well as residual volume decreases were well correlated (p < 0.0001 and p = 0.01). Both techniques showed good agreement in terms of airflow obstruction reversibility (kappa 0.60).ConclusionAlbuterol vibrating mesh nebulization within a nasal high-flow circuit induces similar bronchodilation to standard facial mask jet nebulization. Beyond pharmacological bronchodilation, nasal high flow by itself may induce small but significant bronchodilation.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0473-8) contains supplementary material, which is available to authorized users.

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

“…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.…”

“…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. 9,[26][27][28][29][30][31] Similar to previous evidence, 28,30,32 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. The findings of this study also showed LFNC is the least efficient delivery interface compared to the MP, FM, and HFNC in children.…”

In vitro evaluation of aerosol drug delivery with and without high flow nasal cannula in children

“…Although there are some studies conducted on aerosol delivery via HFNC, this is the first study that quantified aerosol delivery with and without HFNC using pMDI or the JN in a simulated spontaneously breathing pediatric lung model. Regardless of the aerosol device tested in this study, the administration of aerosols via a facemask with a HFNC in place reduced inhaled dose compared with the administration of aerosol by facemask alone.…”

“…In an effort to reduce infant distress, recent aerosol research suggested the use of high flow nasal cannula (HFNC) as an interface for aerosol drug delivery . Researchers have proposed that medical aerosol could be administered using a vibrating mesh nebulizer with HFNC . Traditionally, HFNC is utilized to avoid mechanical ventilation, maintain patent airways, and improve gas exchange .…”

“…Although previous research quantified aerosol deposition through HFNC combined with jet and mesh nebulizers, aerosol drug delivery with jet nebulizers (JNs) and pressurized metered‐dose inhalers (pMDIs) has not been compared using HFNC. Both pMDI/valved holding chamber (VHC) and JNs require administration with a facemask in this patient population.…”