Nebuliser hood compared to mask in wheezy infants: aerosol therapy without tears!

Abstract

Background: Small volume nebulisers (SVNs) with masks commonly provide aerosol therapy for infants with lung diseases. However, infants and toddlers are often disturbed by and thus reject masks. Aims: To compare the lung deposition efficiency of the "usual" SVN aerosol mask and a prototype hood attached to an SVN. The advantage of the hood is that no mask is needed and medication can readily be administered during sleep. Methods:99m Tc salbutamol solution was administered at random by SVN plus mask or hood to 14 wheezy infants (mean age 8 (SD 5) months). The dose and distribution of salbutamol were evaluated using gamma scintigraphy. Clinical response, tolerability by the infants, and parent preference were also compared. Results: Mean total lung deposition was 2.6% with the hood and 2.4% with the mask (p > 0.05). Variability with the mask was greater than with the hood (coefficient of variation (CoV) 54% v 39%). Both treatments provided similar clinical benefit and side effects as reflected in improved oxygen saturation, reduced respiratory frequency, and increased heart rate. Infants accepted the hood better than the mask and there was a positive correlation between poor acceptance and upper airways and stomach deposition for both treatment modalities. Parents preferred the hood treatments. Conclusions: Aerosol therapy by hood is as efficient as by mask but provides a better therapeutic index. It is much better tolerated by infants and preferred by parents. Hood nebulisation is a simple and patient friendly mode of aerosol therapy in wheezy infants.

Hood versus mask nebulization in infants with evolving bronchopulmonary dysplasia in the neonatal intensive care unit

“…We did not observe changes in oxygen saturation and oxygen requirements, and this may be related to our population that had only mild BPD, and was relatively stable, or to the effectiveness of the treatment that is debatable in infants with BPD. In contrast to our study, Amirav et al 7 in a different population of wheezy infants, showed improved oxygen saturation, reduced respiratory rate and increased heart rate with both techniques.…”

“…Irritation and agitation could greatly reduce the drug delivery to the infant's lungs and reduce treatment efficiency. 7,13,14 This could explain in part our findings of some clinical advantage of hood versus mask nebulization. Infant's comfort plays an important role in growing premies.…”

“…Similar findings of better tolerability were reported in wheezy infants. 7 After mask nebulization, heart rate increased significantly (Table 4). This could suggest a more significant systemic effect, but as all the other measures remained stable, the more plausible explanation is that it is another reflection of irritation and discomfort related to the facemask application.…”

“…Furthermore, oxygen is routinely given via hood to infants in the NICU. Amirav et al 7 recently demonstrated scintigraphically that inhalation via hood in wheezy infants achieved a comparable lung deposition of salbutamol to that of a conventional facemask.…”

Comparison of HFNC, bubble CPAP and SiPAP on aerosol delivery in neonates: An in‐vitro study

“…The total aerosol lung deposition was lower in infants than in older children. Amirav, Balanov, Gorenberg, Groshar, and Luder (2003) performed a study involving 14 wheezy infants with a mean age of 8 months to compare the effectiveness of aerosol lung deposition via a facemask or a prototype hood using a SVN. A dose of 99mTc Salbutamol (a radiolabelled solution) was randomly administered by either the facemask or the hood with the SVN using a flow rate of 8 LPM.…”