Department of Respiratory Care, Children's Health-Children's Medical Center, Dallas, Texas.
Department of Respiratory Care, Texas State University, Round Rock, Texas.
Pediatr Pulmonol. 2020 Oct;55(10):2596-2602. doi: 10.1002/ppul.24967. Epub 2020 Jul 24.
Use of high flow nasal cannula (HFNC) to deliver aerosolized medications to children has gained considerable interest. However, data on continuous albuterol delivery (CAD) via HFNC are lacking. This study quantified CAD via HFNC/vibrating mesh nebulizer (VMN) and large-volume jet nebulizer (LVN) with face mask (FM) in a pediatric model. Aerosol delivery with two HFNC cannula designs were also compared.
A pediatric manikin was connected to a lung simulator (Vt = 150 mL, RR = 28 breaths/minute, I:E 1:2.4) via collecting filter at the carina. XL Pediatric and SML Adult HFNC designs were tested to determine optimal cannula design for CAD. VMN was placed Before humidifier (37°C), albuterol (5 mg/mL) was nebulized at 3, 6, and 12 L/minute (n = 3). To compare HFNC/VMN with LVN and FM, albuterol (15 mg/hour) was aerosolized for 3 hours/device (n = 3). LVN was connected to FM and filled with 9 mL of albuterol (5 mg/mL) and 66 mL of normal saline to deliver 25 mL/hour at 13 L/minute. VMN was connected to the infusion pump to deliver 7.5 mL/hr of albuterol (2 mg/mL). Drug eluted from filters was assayed with UV spectrophotometry (276 nm).
Optimal aerosol delivery occurred at 3 L/minute (12.6% ± 0.5%) with SML Adult HFNC (P = .04). When used for CAD, inhaled drug delivery with HFNC/VMN (2.2 mg/hr ± 0.1, 14.8% ± 0.7%) was significantly greater than LVN and FM (0.48 ± 0.09 mg/hour, 3.2% ± 0.6%) (P = .001).
Administration of CAD via HFNC/VMN led to a greater than fourfold increase in drug delivery compared to LVN with FM. Optimal aerosol delivery occurred at 3 L/minute with SML Adult HFNC.
高流量鼻导管（HFNC）在输送雾化药物方面引起了广泛关注。然而，HFNC 连续输送沙丁胺醇（CAD）的数据仍缺乏。本研究通过小儿模型，量化了 HFNC/振动网式雾化器（VMN）和大容积射流雾化器（LVN）联合面罩（FM）输送 CAD 的情况，并比较了两种 HFNC 鼻塞设计的雾化输送效果。
通过隆突处的收集过滤器将小儿模型与肺模拟器（潮气量 150ml，呼吸频率 28 次/分钟，I:E 1:2.4）相连。测试 XL 小儿型和 SML 成人型 HFNC 设计，以确定 CAD 最佳的鼻塞设计。将 VMN 置于加湿器前（37°C），以 3、6 和 12L/分钟的速度雾化沙丁胺醇（5mg/ml）（n=3）。为了比较 HFNC/VMN 与 LVN 和 FM，将 HFNC/VMN 与 LVN 和 FM 比较，将 15mg 小时的沙丁胺醇雾化 3 小时/设备（n=3）。LVN 与 FM 相连，并填充 9ml 沙丁胺醇（5mg/ml）和 66ml 生理盐水，以 13L/分钟的速度输送 25ml/小时。VMN 通过输液泵输送 7.5ml/hr 的沙丁胺醇（2mg/ml）。用紫外分光光度法（276nm）检测从过滤器洗脱的药物。
SML 成人型 HFNC 在 3L/分钟时（12.6%±0.5%），气溶胶输送最佳（P=0.04）。当用于 CAD 时，HFNC/VMN 吸入药物输送（2.2mg/hr±0.1，14.8%±0.7%）明显大于 LVN 和 FM（0.48±0.09mg/小时，3.2%±0.6%）（P=0.001）。
HFNC/VMN 联合使用 CAD 治疗可使药物输送量增加四倍以上，明显大于 FM 联合 LVN。SML 成人型 HFNC 在 3L/分钟时，气溶胶输送最佳。
