Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois.
Aerogen Pharma Corp, San Mateo, California.
Respir Care. 2022 Jan;67(1):1-8. doi: 10.4187/respcare.09133. Epub 2021 Oct 20.
Aerosol delivery via high-flow nasal cannula (HFNC) has been increasingly used in recent years. However, the effects of different HFNC devices, nebulizer types, and placement on aerosol deposition remain largely unknown.
An adult manikin with anatomically correct upper airway was used with a collection filter placed between the manikin's trachea and a breathing simulator, composed of a dual-chamber model lung driven by a critical care ventilator. Three HFNC device configurations were compared, with vibrating mesh nebulizer and small-volume nebulizer placed at the humidifier (inlet for Optiflow and outlet for Airvo 2) and proximal to the nasal cannula at gas flows of 10, 20, 40 and 60 L/min, in quiet and distressed breathing patterns. Albuterol (2.5 mg) was nebulized for each condition (no. = 3). The drug was eluted from the collection filter and assayed with ultraviolet spectrophotometry (276 nm).
At all settings, except when a nebulizer was placed proximal to the nasal cannula with the Optiflow and when the HFNC flow was set at 60 L/min, the vibrating mesh nebulizer generated a higher inhaled dose than did the small-volume nebulizer (all < .05). With the exception of distressed breathing at an HFNC flow of 10 L/min, the inhaled dose with the vibrating mesh nebulizer placed at the humidifier was greater than with the vibrating mesh nebulizer placed proximal to the nasal cannula (all < .05), Optiflow provided a higher inhaled dose than did Airvo 2 with either AirSpiral or 900PT501 circuits with the vibrating mesh nebulizer placed at the humidifier (all < .05).
During transnasal aerosol delivery, the vibrating mesh nebulizer generated a higher inhaled dose than did the small-volume nebulizer when the nebulizer was placed at the humidifier. With the vibrating mesh nebulizer placed at the humidifier and an HFNC flow > 10 L/min, the inhaled dose was higher than with the vibrating mesh nebulizer placed proximal to the nasal cannula, and the inhaled dose was higher with Optiflow than with Airvo 2.
近年来，高流量鼻导管（HFNC）输送气溶胶的应用日益增多。然而，不同的 HFNC 设备、喷雾器类型和位置对气溶胶沉积的影响在很大程度上仍不清楚。
使用具有解剖学正确的上呼吸道的成人人体模型，在人体模型的气管和由重症监护通风机驱动的双腔模型肺组成的呼吸模拟器之间放置收集过滤器。比较了三种 HFNC 设备配置，在加湿罐（Optiflow 的入口和 Airvo 2 的出口）中放置振动网式喷雾器和小容量喷雾器，并在气体流量为 10、20、40 和 60 L/min 时将其放置在鼻塞的近端，在安静和呼吸困难的呼吸模式下。对每种条件（n = 3）都进行沙丁胺醇（2.5 mg）雾化。用紫外分光光度法（276nm）从收集过滤器洗脱药物并进行测定。
除了当喷雾器放在 Optiflow 的鼻塞近端且 HFNC 流量设置为 60 L/min 以外，在所有设置下，振动网式喷雾器产生的吸入剂量均高于小容量喷雾器（均<.05）。除了 HFNC 流量为 10 L/min 的呼吸困难外，在加湿器中放置振动网式喷雾器的吸入剂量大于在鼻塞近端放置振动网式喷雾器的吸入剂量（均<.05），Optiflow 提供的吸入剂量高于 Airvo 2 与振动网式喷雾器在加湿器中放置时的 AirSpiral 或 900PT501 回路（均<.05）。
在经鼻输送气溶胶期间，当喷雾器放置在加湿器中时，振动网式喷雾器产生的吸入剂量高于小容量喷雾器。当振动网式喷雾器放置在加湿器中且 HFNC 流量>10 L/min 时，吸入剂量高于在鼻塞近端放置振动网式喷雾器，且 Optiflow 的吸入剂量高于 Airvo 2。
