Li Jie, Fink James B
Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, IL, USA.
Aerogen Pharma Corp, San Mateo, CA, USA.
Ann Transl Med. 2021 Apr;9(7):590. doi: 10.21037/atm-20-7383.
Using high-flow nasal cannula (HFNC) as a "vehicle" to administer aerosolized medication has attracted clinicians' interest in recent years. In this paper, we summarize the current evidence to answer the common questions raised by clinicians about this new aerosol delivery route and best practices of administration. Benefits of trans-nasal aerosol delivery include increased comfort, ability to speak, eat, and drink for patients while meeting a range of oxygen requirements, particularly for those who need to inhale aerosolized medication for long periods. Aerosol administration via HFNC has been shown to be well tolerated by children and adults, with comparable or better delivery efficacy than other interfaces, ranging from 2-20%. and scintigraphy studies among pediatric and adult populations reported that the inhaled dose delivered via a vibrating mesh nebulizer is 2 to 3 fold greater than that via a jet nebulizer. For adults, placement of nebulizer at the inlet of humidifier increases inhaled dose while reducing rainout obstructing nasal prongs. When HFNC gas flow is set below patient inspiratory flow, aerosol deposition is higher than when the gas flow exceeds patient inspiratory flow; thus, if tolerated, titrating down HFNC gas flow during trans-nasal aerosol delivery, with close monitoring and the use of unit dose with high concentration are recommended. Trans-nasal pulmonary aerosol delivery has not been shown to increase bioaerosols generated by patients, but gas flow may disperse aerosols. Placement of a surgical or procedure mask over HFNC might reduce aerosol dispersion.
近年来，使用高流量鼻导管（HFNC）作为雾化药物给药的“载体”引起了临床医生的关注。在本文中，我们总结了当前的证据，以回答临床医生关于这种新的雾化给药途径及最佳给药方法提出的常见问题。经鼻雾化给药的益处包括提高舒适度，使患者在满足一系列氧气需求的同时能够说话、进食和饮水，特别是对于那些需要长期吸入雾化药物的患者。已证明通过HFNC进行雾化给药在儿童和成人中耐受性良好，其给药效果与其他接口相当或更好，范围为2%至20%。儿科和成人人群的闪烁显像研究报告称，通过振动网式雾化器输送的吸入剂量比喷射式雾化器高2至3倍。对于成人，将雾化器放置在加湿器入口处可增加吸入剂量，同时减少阻碍鼻导管的水珠飞溅。当HFNC气流设置低于患者吸气流量时，雾化沉积高于气流超过患者吸气流量时；因此，如果患者耐受，建议在经鼻雾化给药期间降低HFNC气流，并密切监测，同时使用高浓度单位剂量。经鼻肺部雾化给药尚未显示会增加患者产生的生物气溶胶，但气流可能会使气溶胶扩散。在HFNC上放置手术或操作面罩可能会减少气溶胶扩散。
