Kelly Susyn, Valentine Matthew, Chua Wei Hang, Tatkov Stanislav
Fisher & Paykel Healthcare, Auckland, New Zealand.
Department of Biomedical Sciences, Ross University, Basseterre, St Kitts and Nevis.
ERJ Open Res. 2023 Jun 12;9(3). doi: 10.1183/23120541.00724-2022. eCollection 2023 May.
Nebulised drugs, including osmotic agents and saline, are increasingly used during noninvasive respiratory support, including nasal high-flow therapy. The authors conducted an study to compare the hydration effect of nebulised isotonic 0.9% and hypertonic 7.0% saline on mucociliary transport.
In a perfused organ bath, 10 sheep tracheas were exposed to 7.5 mL nebulised 0.9% and 7.0% saline entrained into heated (38°C) and humidified air delivered at high and low flow (20 and 7 L·min, respectively). Simultaneous measurements of the airway surface liquid height, mucus transport velocity, cilia beat frequency and surface temperature were made over time. The data are presented as mean±sd.
The airway surface liquid height increased significantly with both 0.9% and 7.0% saline: at low-flow by 37.2±10.0 µm and 152.7±10.9 µm, respectively, and at high-flow by 62.3±5.6 µm and 163.4±25.4 µm, respectively (p<0.001). Mucus velocity was increased by both 0.9% and 7.0% saline from a baseline of 8.2±0.8 mm·min to 8.8±0.7 mm·min and 17.1±0.5 mm·min, respectively, with low-flow and at high-flow to 9.8±0.02 mm·min (p=0.04) and 16.9±0.5 mm·min (p<0.05), respectively. Ciliary beating did not change with 0.9% saline, but declined from 13.1±0.6 Hz to 10.2±0.6 Hz and 11.1±0.6 Hz (p<0.05) with 7.0% saline at low- and high-flow, respectively.
The findings demonstrate that nebulised isotonic 0.9% saline, like hypertonic 7.0% saline, significantly stimulates basal mucociliary transport, and the use of high-flow delivery had no significantly different hydration effects compared with low-flow delivery. Hypertonic 7.0% saline suppressed ciliary beating, indicating an increase in airway surface liquid osmolarity, which may have negative effects on the airway surface with frequent use.
雾化药物，包括渗透剂和生理盐水，在无创呼吸支持（包括经鼻高流量治疗）期间的使用越来越普遍。作者开展了一项研究，比较雾化等渗0.9%和高渗7.0%生理盐水对黏液纤毛运输的水化作用。
在一个灌注器官浴槽中，将10只绵羊的气管暴露于7.5毫升雾化的0.9%和7.0%生理盐水中，这些生理盐水被夹带在加热（38°C）和加湿的空气中，分别以高流量和低流量（分别为20和7升·分钟）输送。随时间同时测量气道表面液体高度、黏液运输速度、纤毛摆动频率和表面温度。数据以平均值±标准差表示。
0.9%和7.0%生理盐水均使气道表面液体高度显著增加：低流量时分别增加37.2±10.0微米和152.7±10.9微米，高流量时分别增加62.3±5.6微米和163.4±25.4微米（p<0.001）。0.9%和7.0%生理盐水均使黏液速度从基线的8.2±0.8毫米·分钟分别增加到低流量时的8.8±0.7毫米·分钟和17.1±0.5毫米·分钟，高流量时分别增加到9.8±0.02毫米·分钟（p=0.04）和16.9±0.5毫米·分钟（p<0.05）。0.9%生理盐水对纤毛摆动无影响，但7.0%生理盐水在低流量和高流量时分别使纤毛摆动频率从13.1±0.6赫兹降至10.2±0.6赫兹和11.1±0.6赫兹（p<0.05）。
研究结果表明，雾化等渗0.9%生理盐水与高渗7.0%生理盐水一样，能显著刺激基础黏液纤毛运输，且高流量输送与低流量输送相比，水化效果无显著差异。高渗7.0%生理盐水抑制了纤毛摆动，表明气道表面液体渗透压升高，频繁使用可能对气道表面产生负面影响。
