Abstract
BackgroundThere is an absence of controlled clinical data showing bronchodilation effectiveness after nebulization via nasal high-flow therapy circuits.ResultsTwenty-five patients with reversible airflow obstruction received, in a randomized order: (1) 2.5 mg albuterol delivered via a jet nebulizer with a facial mask; (2) 2.5 mg albuterol delivered via a vibrating mesh nebulizer placed downstream of a nasal high-flow humidification chamber (30 L/min and 37 °C); and (3) nasal high-flow therapy without nebulization. All three conditions induced significant individual increases in forced expiratory volume in one second (FEV1) compared to baseline. The median change was similar after facial mask nebulization [+ 350 mL (+ 180; + 550); + 18% (+ 8; + 30)] and nasal high flow with nebulization [+ 330 mL (+ 140; + 390); + 16% (+ 5; + 24)], p = 0.11. However, it was significantly lower after nasal high-flow therapy without nebulization [+ 50 mL (− 10; + 220); + 3% (− 1; + 8)], p = 0.0009. FEV1 increases after facial mask and nasal high-flow nebulization as well as residual volume decreases were well correlated (p < 0.0001 and p = 0.01). Both techniques showed good agreement in terms of airflow obstruction reversibility (kappa 0.60).ConclusionAlbuterol vibrating mesh nebulization within a nasal high-flow circuit induces similar bronchodilation to standard facial mask jet nebulization. Beyond pharmacological bronchodilation, nasal high flow by itself may induce small but significant bronchodilation.
Highlights
There is an absence of controlled clinical data showing bronchodilation effectiveness after nebulization via nasal high-flow therapy circuits
Uncontrolled case series are in favour of a clinically significant bronchodilation after delivery of albuterol through an Nasal high-flow (NHF) circuit, no controlled data are available in humans [18]
Adult patients with reversible obstructive lung disease defined as a baseline of forced expiratory volume in one second (FEV1) over vital capacity ratio below 70% and a positive bronchodilator reversibility test (FEV1 increase of at least 12% and 200 mL after inhaled albuterol delivery [19]) as assessed in the past month were included after written informed consent
Summary
There is an absence of controlled clinical data showing bronchodilation effectiveness after nebulization via nasal high-flow therapy circuits. Nasal high-flow (NHF) therapy consists of delivering heated and humidified gas through a nasal cannula, at high flow rates, frequently exceeding patients’ inspiratory flow. This non-invasive respiratory support is increasingly used, among hypoxemic critically ill patients as those high oxygen flow rates very efficiently improve oxygenation and reduce the rate of intubation [1, 2]. In vitro data showed that when placing a vibrating mesh nebulizer close to the humidification chamber and limiting the system flow rate at 30 L/min, significant amounts of drug may be delivered to the respiratory tract [11,12,13,14,15]. Uncontrolled case series are in favour of a clinically significant bronchodilation after delivery of albuterol through an NHF circuit, no controlled data are available in humans [18]
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