showed that infants with acute bronchiolitis tolerated aerosolized β-agonist therapy better during HFNT than with a facemask. There are various types of drug delivery modalities utilized during HFNT, including facemasks, mouthpieces, and nasal cannula. demonstrated in vivo that lung deposition was significantly greater while using a vibrating mesh nebulizer (VMN), in comparison with a jet nebulizer (JN) during adult HFNT. In a recent scintigraphy study, Dugernier et al. The findings in that study clearly indicate that in order to optimize the amount of aerosol exiting the nasal prongs during HFNT, it is necessary for the gas flow rate to be low and the input droplet size to be small, while the nebulizer should be positioned immediately after the humidification chamber. Previously, our group reported a systematic approach to determine the conditions required to yield an optimal emitted dose, thus becoming available for inhalation during HFNT. These include the rate of gas delivered, size of the nasal prongs, humidification system, size of the aerosol droplets, and the type and position of aerosol generator. Several factors have been reported to affect the quantity of aerosol exiting the cannula during HFNT. Examples of medications that have been delivered concurrently via aerosol include bronchodilators and mucolytics in the treatment of chronic and acute episodes of respiratory illness, such as chronic obstructive pulmonary disease (COPD) and asthma. The mounting clinical evidence in combination with its ease of use and patient tolerability has resulted in increasing adoption of HFNT, with a particular interest in concurrent aerosol delivery during HFNT. HFNT provides flow rates that equal or exceed inspiratory flow and reduces the inspiratory resistance associated with the nasopharynx, thus reducing the work of breathing. High-flow nasal therapy (HFNT) is a means of delivering heated humidified air to patient airways that facilitates higher gas flows than conventional low-flow therapy. This article will be of considerable benefit in enhancing the understanding of aerosol delivery during HFNT, an increasingly adopted therapeutic intervention by healthcare professionals. Furthermore, across all drug delivery interfaces, and in line with previous reports, aerosol delivery was greater during simulated distressed breathing, in comparison with simulated healthy adult breathing. Aerosol delivery was also greater when the VMN was integrated into HFNT (6.81 ± 0.45%), in comparison with using the JN with a facemask (5.72 ± 0.71%) or a mouthpiece (0.69 ± 0.53%). During simulated distressed breathing, a significantly greater aerosol dose was observed when the VMN was integrated with HFNT, supplying aerosol and humidified air simultaneously (6.81 ± 0.45%), compared with using a facemask (0.86 ± 0.04%, 2.96 ± 0.26%, and 4.23 ± 0.93% at 0LPM, 2LPM, and 6LPM) or mouthpiece (0.73 ± 0.37%, 0.97 ± 0.20%, and 3.11 ± 0.53% at 0LPM, 2LPM, and 6LPM, respectively). In addition, aerosol delivery was also significantly greater when the VMN was integrated into simulated HFNT (2.88 ± 0.15%), in comparison with using the jet nebulizer (JN) with a facemask (0.82 ± 0.16%) or a mouthpiece (0.86 ± 0.11%). Resultsĭuring simulated healthy breathing, a significantly greater aerosol dose was observed when the vibrating mesh nebulizer (VMN) was integrated with HFNT alone, supplying aerosol and humidified air simultaneously (2.88 ± 0.15%), as opposed to using with a facemask (0.33 ± 0.07%, 1.62 ± 0.46%, and 1.07 ± 0.25% at 0 L/min (LPM), 2LPM, and 6LPM, respectively) or mouthpiece (0.56 ± 0.13%, 2.16 ± 0.06%, and 1.82 ± 0.41% at 0LPM, 2LPM, and 6LPM). Aerosol dose was determined by quantifying the mass of drug captured on a filter positioned distal to the trachea. Both healthy breathing pattern and distressed breathing patterns were utilized. The head model was connected to a breathing simulator via a collection filter. MethodsĪ facemask or mouthpiece and/or a nasal cannula were positioned on an anatomically correct adult head model. The objective of this study was to address this gap in the literature and evaluate aerosol delivery using two nebulizer types across different drug delivery interfaces, nasal cannula, facemask, and mouthpiece, during simulated adult HFNT. Few studies have compared aerosol delivery across various delivery interfaces during HFNT. Current clinical practice during high-flow nasal therapy (HFNT) involves utilization of a nasal cannula to provide humidification, with a facemask placed over the cannula to deliver aerosol.
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