高流量鼻导管下两个雾化器输送气溶胶：一项随机交叉单光子发射计算机断层扫描-计算机断层扫描研究。

Aerosol Delivery with Two Nebulizers Through High-Flow Nasal Cannula: A Randomized Cross-Over Single-Photon Emission Computed Tomography-Computed Tomography Study.

机构信息

1 Institut de Recherche Expérimentale et Clinique (IREC), Pneumologie, ORL and Dermatologie, Cliniques Universitaires Saint-Luc , Brussels, Belgium .

2 Soins Intensifs, Cliniques Universitaires Saint-Luc , Brussels, Belgium .

出版信息

J Aerosol Med Pulm Drug Deliv. 2017 Oct;30(5):349-358. doi: 10.1089/jamp.2017.1366. Epub 2017 May 2.

DOI:10.1089/jamp.2017.1366

PMID:28463044

Abstract

BACKGROUND

High-flow nasal cannula use is developing in ICUs. The aim of this study was to compare aerosol efficiency by using two nebulizers through a high-flow nasal cannula: the most commonly used jet nebulizer (JN) and a more efficient vibrating-mesh nebulizer (VN).

METHODS

Aerosol delivery of diethylenetriaminepentaacetic acid labeled with technetium-99m (4 mCi/4 mL) to the lungs by using a VN (Aerogen Solo; Aerogen Ltd., Galway, Ireland) and a constant-output JN (Opti-Mist Plus Nebulizer; ConvaTec, Bridgewater, NJ) through a high-flow nasal cannula (Optiflow; Fisher & Paykel, New Zealand) was compared in six healthy subjects. Flow rate was set at 30 L/min through the heated humidified circuit. Pulmonary and extrapulmonary deposition was measured by single-photon emission computed tomography combined with a low-dose computed tomographic scan and by planar scintigraphy.

RESULTS

Lung deposition was only 3.6 (2.1-4.4) and 1 (0.7-2)% of the nominal dose with the VN and the JN, respectively (p < 0.05). The JN showed higher retained doses than the VN. However, both nebulizers were associated with substantial deposition in the single limb circuit, the humidification chamber, and the nasal cannula [58.2 (51.6-61.6)% of the nominal dose with the VN versus 19.2 (15.8-22.9)% of the nominal dose with the JN, p < 0.05] and in the upper respiratory tract [17.6 (13.4-27.9)% of the nominal dose with the VN and 8.6 (6.0-11.0)% of the nominal dose with the JN, p < 0.05], especially in the nasal cavity.

CONCLUSIONS

In the specific conditions of the study, pulmonary drug delivery through the high-flow nasal cannula is about 1%-4% of the initial amount of drugs placed in the nebulizer, despite the higher efficiency of the VN as compared with the JN.

摘要

背景

高流量鼻导管在 ICU 中得到了广泛应用。本研究旨在比较两种通过高流量鼻导管进行喷雾的喷雾器的气溶胶效率：最常用的射流喷雾器（JN）和更高效的振动网式喷雾器（VN）。

方法

使用 VN（Aerogen Solo；Aerogen Ltd.，戈尔韦，爱尔兰）和恒流 JN（Opti-Mist Plus 喷雾器；ConvaTec，Bridgewater，NJ）通过高流量鼻导管（Optiflow；Fisher & Paykel，新西兰）向 6 名健康受试者的肺部输送二乙三胺五乙酸（用 technetium-99m 标记，4 mCi/4 mL），并对其进行比较。加热湿化回路的流速设定为 30 L/min。通过单光子发射计算机断层扫描结合低剂量计算机断层扫描和平面闪烁扫描来测量肺内和肺外沉积。

结果

VN 和 JN 的肺沉积率分别仅为名义剂量的 3.6（2.1-4.4）和 1（0.7-2）%（p<0.05）。JN 显示出比 VN 更高的保留剂量。然而，两种喷雾器都与单肢回路、湿化室和鼻导管中的大量沉积有关[VN 为名义剂量的 58.2（51.6-61.6）%，而 JN 为名义剂量的 19.2（15.8-22.9）%，p<0.05]，以及上呼吸道[VN 为名义剂量的 17.6（13.4-27.9）%，而 JN 为名义剂量的 8.6（6.0-11.0）%，p<0.05]，尤其是鼻腔。