Bennett Gavin, Joyce Mary, Fernández Elena Fernández, MacLoughlin Ronan
Aerogen Limited, IDA Business Park, Dangan, Galway, Ireland.
Intensive Care Med Exp. 2019 Apr 3;7(1):20. doi: 10.1186/s40635-019-0245-2.
Current clinical practice during high-flow nasal therapy (HFNT) involves utilization of a nasal cannula to provide humidification, with a facemask placed over the cannula to deliver aerosol. Few studies have compared aerosol delivery across various delivery interfaces during HFNT. The objective of this study was to address this gap in the literature and evaluate aerosol delivery using two nebulizer types across different drug delivery interfaces, nasal cannula, facemask, and mouthpiece, during simulated adult HFNT.
A facemask or mouthpiece and/or a nasal cannula were positioned on an anatomically correct adult head model. The head model was connected to a breathing simulator via a collection filter. Both healthy breathing pattern and distressed breathing patterns were utilized. Aerosol dose was determined by quantifying the mass of drug captured on a filter positioned distal to the trachea.
During simulated healthy breathing, a significantly greater aerosol dose was observed when the vibrating mesh nebulizer (VMN) was integrated with HFNT alone, supplying aerosol and humidified air simultaneously (2.88 ± 0.15%), as opposed to using with a facemask (0.33 ± 0.07%, 1.62 ± 0.46%, and 1.07 ± 0.25% at 0 L/min (LPM), 2LPM, and 6LPM, respectively) or mouthpiece (0.56 ± 0.13%, 2.16 ± 0.06%, and 1.82 ± 0.41% at 0LPM, 2LPM, and 6LPM). In addition, aerosol delivery was also significantly greater when the VMN was integrated into simulated HFNT (2.88 ± 0.15%), in comparison with using the jet nebulizer (JN) with a facemask (0.82 ± 0.16%) or a mouthpiece (0.86 ± 0.11%). During simulated distressed breathing, a significantly greater aerosol dose was observed when the VMN was integrated with HFNT, supplying aerosol and humidified air simultaneously (6.81 ± 0.45%), compared with using a facemask (0.86 ± 0.04%, 2.96 ± 0.26%, and 4.23 ± 0.93% at 0LPM, 2LPM, and 6LPM) or mouthpiece (0.73 ± 0.37%, 0.97 ± 0.20%, and 3.11 ± 0.53% at 0LPM, 2LPM, and 6LPM, respectively). Aerosol delivery was also greater when the VMN was integrated into HFNT (6.81 ± 0.45%), in comparison with using the JN with a facemask (5.72 ± 0.71%) or a mouthpiece (0.69 ± 0.53%). Furthermore, across all drug delivery interfaces, and in line with previous reports, aerosol delivery was greater during simulated distressed breathing, in comparison with simulated healthy adult breathing.
This article will be of considerable benefit in enhancing the understanding of aerosol delivery during HFNT, an increasingly adopted therapeutic intervention by healthcare professionals.
高流量鼻导管治疗（HFNT）期间的当前临床实践包括使用鼻导管进行加湿，并在导管上放置面罩以输送气雾剂。很少有研究比较HFNT期间通过各种输送界面的气雾剂输送情况。本研究的目的是填补这一文献空白，并评估在模拟成人HFNT期间，使用两种雾化器类型通过不同药物输送界面（鼻导管、面罩和口含器）的气雾剂输送情况。
将面罩或口含器和/或鼻导管放置在解剖结构正确的成人头部模型上。头部模型通过收集过滤器连接到呼吸模拟器。使用了健康呼吸模式和窘迫呼吸模式。通过量化捕获在气管远端过滤器上的药物质量来确定气雾剂剂量。
在模拟健康呼吸期间，当振动网雾化器（VMN）单独与HFNT整合，同时供应气雾剂和加湿空气时，观察到气雾剂剂量显著更高（2.88±0.15%），与使用面罩（在0升/分钟（LPM）、2LPM和6LPM时分别为0.33±0.07%、1.62±0.46%和1.07±0.25%）或口含器（在0LPM、2LPM和6LPM时分别为0.56±0.13%、2.16±0.0《和1.82±0.41%）相比。此外，与使用面罩（0.82±0.16%）或口含器（0.86±0.11%）的喷射雾化器（JN）相比，当VMN整合到模拟HFNT中时，气雾剂输送也显著更高（2.88±0.15%）。在模拟窘迫呼吸期间，当VMN与HFNT整合，同时供应气雾剂和加湿空气时，观察到气雾剂剂量显著更高（6.81±0.45%），与使用面罩（在《LPM、2LPM和6LPM时分别为0.86±0.04%、2.96±0.26%和4.23±0.93%）或口含器（在0LPM、2LPM和6LPM时分别为0.73±0.37%、0.97±0.20%和3.11±0.53%）相比。与使用面罩（5.72±0.71%）或口含器（0.69±《53%）的JN相比，当VMN整合到HFNT中时，气雾剂输送也更高（6.81±0.45%）。此外，在所有药物输送界面上，与模拟健康成人呼吸相比，如先前报道所示，模拟窘迫呼吸期间的气雾剂输送更高。
本文对于增强对HFNT期间气雾剂输送的理解将有很大帮助，HFNT是医疗保健专业人员越来越多地采用的一种治疗干预措施。
