Calabrese Cecilia, Annunziata Anna, Mariniello Domenica Francesca, Allocca Valentino, Imitazione Pasquale, Cauteruccio Rosa, Simioli Francesca, Fiorentino Giuseppe
Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
Department of Intensive Care, Azienda Ospedaliera di Rilievo Nazionale dei Colli, Naples, Italy.
Front Med (Lausanne). 2023 Jan 18;9:1098427. doi: 10.3389/fmed.2022.1098427. eCollection 2022.
High-flow nasal cannula (HFNC) therapy is an oxygen delivery method particularly used in patients affected by hypoxemic respiratory failure. In comparison with the conventional "low flow" oxygen delivery systems, it showed several important clinical benefits. The possibility to nebulize drugs HFNC represents a desirable medical practice because it allows the administration of inhaled drugs, mostly bronchodilators, without the interruption or modification of the concomitant oxygen therapy. HFNC, by itself has shown to exert a small but significant bronchodilator effect and improves muco-ciliary clearance; thus, the nebulization of bronchodilators through the HFNC circuit may potentially increase their pharmacological activity. Several technical issues have been observed which include the type of the nebulizer that should be used, its position within the HFNC circuit, and the optimal gas flow rates to ensure an efficient drug delivery to the lungs both in "quiet" and "distressed" breathing patterns. The aim of this review has been to summarize the scientific evidence coming from "" studies and to discuss the results of "" studies performed in adult subjects, mainly affected by obstructive lung diseases. Most studies seem to indicate the vibrating mesh nebulizer as the most efficient type of nebulizer and suggest to place it preferentially upstream from the humidifier chamber. In a quite breathing patterns, the inhaled dose seems to increase with lower flow rates while in a "distressed" breathing pattern, the aerosol delivery is higher when gas flow was set below the patient's inspiratory flow, with a plateau effect seen when the gas flow reaches approximately 50% of the inspiratory flow. Although several studies have demonstrated that the percentage of the loaded dose nebulized HFNC reaching the lungs is small, the bronchodilator effect of albuterol seems not to be impaired when compared to the conventional inhaled delivery methods. This is probably attributed to its pharmacological activity. Prospective and well-designed studies in different cohort of patients are needed to standardize and demonstrate the efficacy of the procedure.
高流量鼻导管（HFNC）疗法是一种专门用于治疗低氧性呼吸衰竭患者的氧输送方法。与传统的“低流量”氧输送系统相比，它显示出若干重要的临床益处。HFNC能够雾化药物，这是一种理想的医疗实践，因为它允许在不中断或改变伴随的氧疗的情况下给予吸入药物，主要是支气管扩张剂。HFNC本身已显示出具有轻微但显著的支气管扩张作用，并改善黏液纤毛清除功能；因此，通过HFNC回路雾化支气管扩张剂可能会潜在地增加其药理活性。已经观察到一些技术问题，包括应使用的雾化器类型、其在HFNC回路中的位置以及最佳气体流速，以确保在“安静”和“窘迫”呼吸模式下都能有效地将药物输送到肺部。本综述的目的是总结来自“……”研究的科学证据，并讨论在主要受阻塞性肺疾病影响的成年受试者中进行的“……”研究的结果。大多数研究似乎表明振动网式雾化器是最有效的雾化器类型，并建议将其优先放置在湿化器腔室的上游。在安静呼吸模式下，吸入剂量似乎随着较低流速而增加，而在“窘迫”呼吸模式下，当气体流速设置低于患者吸气流速时，气溶胶输送量更高，当气体流速达到吸气流速的约50%时会出现平台效应。尽管多项研究表明通过HFNC雾化到达肺部的加载剂量百分比很小，但与传统吸入给药方法相比，沙丁胺醇的支气管扩张作用似乎并未受到损害。这可能归因于其药理活性。需要在不同患者队列中进行前瞻性且设计良好的研究，以规范并证明该操作的疗效。
