Decrease the flow setting to improve trans‐nasal pulmonary aerosol delivery via "high‐flow nasal cannula" to infants and toddlers. Issue 6 (28th March 2019)

• Record Type: Journal Article
• Authors: Li, Jie; Gong, Lingyue; Ari, Arzu; Fink, James B.
• Is Part Of: Pediatric pulmonology. Volume 54:Issue 6(2019)
• Page Start: 914
• Page End: 921
• Publication Date: 2019-03-28
• Subjects: aerosol -- flow -- high‐flow nasal cannula -- oxygen inhalation therapy; Pediatric respiratory diseases -- Periodicals; Pediatrics -- Periodicals; 618.922
• DOI: 10.1002/ppul.24274
• Languages: English
• ISSNs: 8755-6863

Abstract

Abstract: Objectives: Trans‐nasal pulmonary aerosol delivery for infants and toddlers has recently gained popularity, however, the reported lung deposition is low. We aimed to investigate the influential factors to improve the delivery. Methods: Anatomic airway manikins simulating infant (5 kg) and toddler (15 kg) with collecting filter connected the trachea and breath simulator, were set to represent quiet and distressed breathing. Nasal cannula flow was set at 0.125, 0.25, 0.5, 1, and 2 L/kg/min. A mesh nebulizer (Aerogen) was placed at the inlet of humidifier (Fisher & Paykel) and proximal to patient. Albuterol (5 mg in 1 mL) was nebulized for each condition ( n = 3). Drug was eluted from the filter and assayed with UV spectrophotometry (276 nm). Results: Inhaled dose was higher with nebulizer placed at the inlet of humidifier than proximal to patient in all settings, except the infant model at low gas flow settings (0.125 and 0.25 L/kg/min). When nebulizer was placed at the inlet of humidifier, inhaled dose was higher when gas flow was below patient's inspiratory flow than when gas flow exceeded patient's inspiratory flow (8.77 ± 3.84 vs 2.16 ± 1.29%, P < 0.001); aerosol deposition increased as gas flow decreased, with greatest deposition at gas flow of 0.25 L/kg/min (11.29 ± 2.15%). A multiple linear regression identified gas flow as the primary predictor of aerosol delivery. Conclusions: Trans‐nasal pulmonary aerosol delivery was significantly improved when gas flow was below patient's inspiratory flow, aerosol deposition increased with decreased nasal cannula flow, with greatest deposition at 0.25 L/kg/min.