Sunbul Fatemah S, Fink James B, Harwood Robert, Sheard Meryl M, Zimmerman Ralph D, Ari Arzu
Georgia State University, Division of Respiratory Therapy, Atlanta, Georgia.
Pediatr Pulmonol. 2015 Nov;50(11):1099-106. doi: 10.1002/ppul.23123. Epub 2014 Dec 9.
UNLABELLED: Aerosol drug delivery via high flow nasal cannula (HFNC), bubble continuous positive airway pressure (CPAP), and synchronized inspiratory positive airway pressure (SiPAP) has not been quantified in spontaneously breathing premature infants. OBJECTIVES: The purpose of this study was to compare aerosol delivery via HFNC, bubble CPAP, and SiPAP in a model of a simulated spontaneously breathing preterm infant. WORKING HYPOTHESIS: The types of CPAP systems and nebulizer positions used during aerosol therapy will impact aerosol deposition in simulated spontaneously breathing infants. STUDY DESIGN: Quantitative, comparative, in-vitro study. METHODOLOGY: A breath simulator was set to preterm infant settings (VT : 9 ml, RR: 50 bpm and Ti: 0.5 sec) and connected to the trachea of an anatomical upper airway model of a preterm infant via collecting filter distal to the trachea. The HFNC (Optiflow; Fisher & Paykel), Bubble CPAP (Fisher & Paykel), and SiPAP (Carefusion) were attached to the nares of the model via each device's proprietary nasal cannula and set to deliver a baseline of 5 cm H2 O pressure. Albuterol sulfate (2.5 mg/0.5 ml) was aerosolized with a mesh nebulizer (Aeroneb Solo) positioned(1) proximal to the patient and(2) prior to the humidifier (n = 5). The drug was eluted from the filter with 0.1 N HCl and analyzed via spectrophotometry (276 nm). Data were analyzed using descriptive statistics, t-tests, and one-way analysis of variance (ANOVA), with P < 0.05 significant. RESULTS: At position 1, the trend of lower deposition (mean ± SD%) across devices was not significant (0.90 ± 0.26, 0.70 ± 0.16 and 0.59 ± 0.19, respectively; P = 0.098); however, in position 2, drug delivery with SiPAP (0.79 ± 0.11) was lower compared to both HFNC (1.30 ± 0.17; P = 0.003) and bubble CPAP (1.24 ± 0.24; p = 0.008). Placement of the nebulizer prior to the humidifier increased deposition with all devices (P < 0.05). CONCLUSIONS: Aerosol can be delivered via all three devices used in this study. Device selection and nebulizer position impacted aerosol delivery in this simulated model of a spontaneously breathing preterm infant.
未标注：通过高流量鼻导管（HFNC）、气泡持续气道正压通气（CPAP）和同步吸气气道正压通气（SiPAP）进行的气溶胶药物递送，在自主呼吸的早产儿中尚未得到量化。 目的：本研究的目的是在模拟自主呼吸的早产儿模型中，比较通过HFNC、气泡CPAP和SiPAP进行的气溶胶递送。 工作假设：气溶胶治疗期间使用的CPAP系统类型和雾化器位置将影响模拟自主呼吸婴儿中的气溶胶沉积。 研究设计：定量、比较性体外研究。 方法：将呼吸模拟器设置为早产儿参数（潮气量：9毫升，呼吸频率：50次/分钟，吸气时间：0.5秒），并通过气管远端的收集过滤器连接到早产儿解剖学上气道模型的气管。HFNC（Optiflow；费雪派克）、气泡CPAP（费雪派克）和SiPAP（Carefusion）通过各自设备的专用鼻导管连接到模型的鼻孔，并设置为输送5厘米水柱压力的基线。硫酸沙丁胺醇（2.5毫克/0.5毫升）用网状雾化器（Aeroneb Solo）雾化，雾化器位置分别为（1）靠近患者处和（2）在加湿器之前（n = 5）。药物用0.1N盐酸从过滤器中洗脱，并通过分光光度法（276纳米）进行分析。数据使用描述性统计、t检验和单因素方差分析（ANOVA）进行分析，P < 0.05为有显著性差异。 结果：在位置1，各设备间较低沉积趋势（平均值±标准差%）不显著（分别为0.90±0.26、0.70±0.16和0.59±0.19；P = 0.098）；然而，在位置2，与HFNC（1.30±0.17；P = 0.003）和气泡CPAP（1.24±0.24；P = 0.008）相比，SiPAP的药物递送量（0.79±0.11）较低。在加湿器之前放置雾化器可增加所有设备的沉积量（P < 0.05）。 结论：本研究中使用的所有三种设备均可进行气溶胶递送。在这个模拟的自主呼吸早产儿模型中，设备选择和雾化器位置会影响气溶胶递送。
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