Alcoforado Luciana, Ari Arzu, Barcelar Jacqueline de Melo, Brandão Simone Cristina S, Fink James B, de Andrade Armele Dornelas
Department of Physical Therapy, Universidade Federal de Pernambuco, Recife 50740-560, PE, Brazil.
Department of Respiratory Therapy, Texas State University, Round Rock, TX 78665, USA.
Pharmaceutics. 2019 Jul 7;11(7):320. doi: 10.3390/pharmaceutics11070320.
Trans-nasal pulmonary aerosol delivery using high flow nasal cannula (HFNC) devices is described with the administration of high gas flows exceeding patient inspiratory flow (HF) and with lower flows (LF). The aim of this pilot clinical trial was to compare deposition and distribution of radiolabeled aerosol via nasal cannula in healthy adults across three rates of gas flow delivered with active heated humidification, and to further identify the impact of aerosol administration without heated humidity.
Twenty-three (23) healthy adults (16F) were randomized to receive aerosol with active heated humidification or unheated oxygen at gas flows of 10 L/min ( = 8), 30 L/min ( = 7), or 50 L/min ( = 8). Diethylenetriaminepentaacetic acid labeled with 1 millicurie (37 MBq) of Technetium-99m (DTPA-Tc99m) was mixed with NaCl to a fill volume of 1 mL, and administered via mesh nebulizer placed at the inlet of the humidifier. Radioactivity counts were performed using a gamma camera and the regions of interest (ROIs) were delimited with counts from the lungs, upper airways, stomach, nebulizer, circuit, and expiratory filter. A mass balance was calculated and each compartment was expressed as a percentage of the total.
Lung deposition (mean ± SD) with heated humidified gas was greater at 10 L/min than 30 L/min or 50 L/min (17.2 ± 6.8%, 5.71 ± 2.04%, and 3.46 ± 1.24%, respectively; = 0.0001). Using unheated carrier gas, a lung dose of aerosol was similar to the active heated humidification condition at 10 L/min, but greater at 30 and 50 L/min ( = 0.011). Administered gas flow and lung deposition were negatively correlated ( = -0.880, < 0.001).
Both flow and active heated humidity inversely impact aerosol delivery through HFNC. Nevertheless, aerosol administration across the range of commonly used flows can provide measurable levels of lung deposition in healthy adult subjects (NCT02519465).
使用高流量鼻导管（HFNC）设备经鼻进行肺部气溶胶给药时，描述了两种情况，即给予超过患者吸气流量的高气体流量（HF）和较低流量（LF）。这项初步临床试验的目的是比较在健康成年人中，通过鼻导管以三种气体流速并采用主动加热湿化方式给予放射性标记气溶胶的沉积和分布情况，并进一步确定不进行加热湿化时气溶胶给药的影响。
23名（16名女性）健康成年人被随机分组，分别接受主动加热湿化的气溶胶或未加热的氧气，气体流速分别为10 L/min（n = 8）、30 L/min（n = 7）或50 L/min（n = 8）。将标记有1毫居里（37 MBq）锝-99m（DTPA-Tc99m）的二乙烯三胺五乙酸与氯化钠混合至1 mL的填充体积，并通过置于加湿器入口处的网状雾化器给药。使用γ相机进行放射性计数，并根据肺部、上呼吸道、胃部、雾化器、回路和呼气过滤器的计数划定感兴趣区域（ROI）。计算质量平衡，并将每个隔室表示为总量的百分比。
采用加热湿化气体时，10 L/min的肺部沉积（平均值±标准差）大于30 L/min或50 L/min（分别为17.2±6.8%、5.71±2.04%和3.46±1.24%；P = 0.0001）。使用未加热的载气时，10 L/min的肺部气溶胶剂量与主动加热湿化情况相似，但在30和5 L/min时更高（P = 0.011）。给药气体流速与肺部沉积呈负相关（r = -0.880，P < 0.0）。
流速和主动加热湿化均对通过HFNC的气溶胶给药产生反向影响。然而，在常用流速范围内进行气溶胶给药可在健康成年受试者中提供可测量的肺部沉积水平（NCT02519465）。
