Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, Illinois.
Department of Respiratory Care, College of Health Professions, Texas State University, Round Rock, Texas.
Pediatr Pulmonol. 2019 Jun;54(6):914-921. doi: 10.1002/ppul.24274. Epub 2019 Mar 28.
Trans-nasal pulmonary aerosol delivery for infants and toddlers has recently gained popularity, however, the reported lung deposition is low. We aimed to investigate the influential factors to improve the delivery.
Anatomic airway manikins simulating infant (5 kg) and toddler (15 kg) with collecting filter connected the trachea and breath simulator, were set to represent quiet and distressed breathing. Nasal cannula flow was set at 0.125, 0.25, 0.5, 1, and 2 L/kg/min. A mesh nebulizer (Aerogen) was placed at the inlet of humidifier (Fisher & Paykel) and proximal to patient. Albuterol (5 mg in 1 mL) was nebulized for each condition (n = 3). Drug was eluted from the filter and assayed with UV spectrophotometry (276 nm).
Inhaled dose was higher with nebulizer placed at the inlet of humidifier than proximal to patient in all settings, except the infant model at low gas flow settings (0.125 and 0.25 L/kg/min). When nebulizer was placed at the inlet of humidifier, inhaled dose was higher when gas flow was below patient's inspiratory flow than when gas flow exceeded patient's inspiratory flow (8.77 ± 3.84 vs 2.16 ± 1.29%, P < 0.001); aerosol deposition increased as gas flow decreased, with greatest deposition at gas flow of 0.25 L/kg/min (11.29 ± 2.15%). A multiple linear regression identified gas flow as the primary predictor of aerosol delivery.
Trans-nasal pulmonary aerosol delivery was significantly improved when gas flow was below patient's inspiratory flow, aerosol deposition increased with decreased nasal cannula flow, with greatest deposition at 0.25 L/kg/min.
经鼻肺部气溶胶传递在婴儿和幼儿中最近越来越受欢迎，然而，据报道肺部沉积率较低。我们旨在研究提高传递的影响因素。
模拟婴儿（5 公斤）和幼儿（15 公斤）的解剖气道模型与收集过滤器连接气管和呼吸模拟器，分别代表安静和呼吸困难的呼吸。鼻管气流设定为 0.125、0.25、0.5、1 和 2 L/kg/min。网孔雾化器（Aerogen）放置在加湿器（Fisher & Paykel）的入口处和患者的近端。在每种情况下（n = 3）雾化沙丁胺醇（1 毫升 5 毫克）。从过滤器洗脱药物并用紫外分光光度法（276nm）测定。
在所有设定中，与在患者近端相比，雾化器放置在加湿器入口处时，吸入剂量更高，除了在低气流设置（0.125 和 0.25 L/kg/min）时的婴儿模型。当雾化器放置在加湿器的入口处时，当气流低于患者吸气流量时，吸入剂量高于当气流超过患者吸气流量时（8.77 ± 3.84 比 2.16 ± 1.29%，P < 0.001）；随着气流的减少，气溶胶沉积增加，在气流为 0.25 L/kg/min 时沉积最大（11.29 ± 2.15%）。多元线性回归确定气流是气溶胶传递的主要预测因子。
当气流低于患者吸气流量时，经鼻肺部气溶胶传递显著改善，气溶胶沉积随鼻管气流的减少而增加，在 0.25 L/kg/min 时沉积最大。
