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Review
. 2020 Aug 17;24(1):506.
doi: 10.1186/s13054-020-03206-9.

A narrative review on trans-nasal pulmonary aerosol delivery

Jie Li  1 , James B Fink  2   3 , Ronan MacLoughlin  4 , Rajiv Dhand  5
Affiliations
Review

A narrative review on trans-nasal pulmonary aerosol delivery

Jie Li et al. Crit Care. .

Abstract

The use of trans-nasal pulmonary aerosol delivery via high-flow nasal cannula (HFNC) has expanded in recent years. However, various factors influencing aerosol delivery in this setting have not been precisely defined, and no consensus has emerged regarding the optimal techniques for aerosol delivery with HFNC. Based on a comprehensive literature search, we reviewed studies that assessed trans-nasal pulmonary aerosol delivery with HFNC by in vitro experiments, and in vivo, by radiolabeled, pharmacokinetic and pharmacodynamic studies. In these investigations, the type of nebulizer employed and its placement, carrier gas, the relationship between gas flow and patient's inspiratory flow, aerosol delivery strategies (intermittent unit dose vs continuous administration by infusion pump), and open vs closed mouth breathing influenced aerosol delivery. The objective of this review was to provide rational recommendations for optimizing aerosol delivery with HFNC in various clinical settings.

Keywords: Aerosol therapy; Asthma; Chronic obstructive pulmonary disease; High-flow nasal cannula; Jet nebulizer; Oxygen therapy; Pulmonary hypertension; Vibrating mesh nebulizer.

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Conflict of interest statement

Dr. Dhand reports remuneration from GSK Pharmaceuticals, Boehringer-Ingelheim, Bayer, Mylan, Teva, and Astra-Zeneca Pharmaceuticals outside the submitted work. Dr. Fink is Chief Science Officer for Aerogen Pharma Corp, San Mateo, CA, USA. Dr. MacLoughlin is the Senior Manager Science for Aerogen Ltd., Galway, Ireland. Dr. Li declares to receive research funding from Fisher & Paykel Healthcare, The Daniel and Ada Rice Foundation. None of the companies had a role in the conception of this review, in the literature search or interpretation, in the writing of the manuscript, or in the decision to publish the results.

Figures

Fig. 1
Fig. 1
Improvement in FEV1 (mL) from baseline after inhalation of 400 mcg albuterol via MDI with spacer or doubling doses of albuterol via VMN with HFNC (cumulative doses of 0.5, 1.5, and 3.5 mg). Figure modified from reference [12]. In 42 bronchodilator responsive patients with asthma or COPD, FEV1 improvement after administration of 400 mcg albuterol via MDI and spacer was higher than that after inhalation of 0.5 mg albuterol via VMN with HFNC, but similar to that observed after inhalation of cumulative doses of 1.5 mg or 3.5 mg of albuterol via VMN with HFNC. COPD, chronic obstructive pulmonary disease; MDI, metered dose inhaler; FEV1, forced expiratory volume in the first second; VMN, vibrating mesh nebulizer; HFNC, high-flow nasal cannula
Fig. 2
Fig. 2
The relationship between inhaled dose and the ratio of HFNC gas flow to patient’s inspiratory flow in adult, toddler, and infant models. Mean and (±) SD values are shown. Figure modified from references [29, 30]. In adult, toddler, and infant in vitro models, as the ratio of HFNC gas flow to patient’s inspiratory flow increased, the delivered dose decreased, with a steep decline in aerosol delivery when HFNC gas flow was more than 2-fold higher than the patient’s inspiratory flow. Inhaled dose peaked when the HFNC gas flow was 0.1–0.5 of the patient’s inspiratory flow. For illustration, data from ratios of 0.1–0. 5, 0.51–1.0, 1.01–2.0, and > 2.0 in the original studies have been combined for this graphic. HFNC, high-flow nasal cannula
See this image and copyright information in PMC

References

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