Restricted accessResearch articleFirst published online 2017-10
Aerosol Delivery with Two Nebulizers Through High-Flow Nasal Cannula: A Randomized Cross-Over Single-Photon Emission Computed Tomography-Computed Tomography Study
High-flow nasal cannula use is developing in ICUs. The aim of this study was to compare aerosol efficiency by using two nebulizers through a high-flow nasal cannula: the most commonly used jet nebulizer (JN) and a more efficient vibrating-mesh nebulizer (VN).
Methods:
Aerosol delivery of diethylenetriaminepentaacetic acid labeled with technetium-99m (4 mCi/4 mL) to the lungs by using a VN (Aerogen Solo®; Aerogen Ltd., Galway, Ireland) and a constant-output JN (Opti-Mist Plus Nebulizer®; ConvaTec, Bridgewater, NJ) through a high-flow nasal cannula (Optiflow®; Fisher & Paykel, New Zealand) was compared in six healthy subjects. Flow rate was set at 30 L/min through the heated humidified circuit. Pulmonary and extrapulmonary deposition was measured by single-photon emission computed tomography combined with a low-dose computed tomographic scan and by planar scintigraphy.
Results:
Lung deposition was only 3.6 (2.1–4.4) and 1 (0.7–2)% of the nominal dose with the VN and the JN, respectively (p < 0.05). The JN showed higher retained doses than the VN. However, both nebulizers were associated with substantial deposition in the single limb circuit, the humidification chamber, and the nasal cannula [58.2 (51.6–61.6)% of the nominal dose with the VN versus 19.2 (15.8–22.9)% of the nominal dose with the JN, p < 0.05] and in the upper respiratory tract [17.6 (13.4–27.9)% of the nominal dose with the VN and 8.6 (6.0–11.0)% of the nominal dose with the JN, p < 0.05], especially in the nasal cavity.
Conclusions:
In the specific conditions of the study, pulmonary drug delivery through the high-flow nasal cannula is about 1%–4% of the initial amount of drugs placed in the nebulizer, despite the higher efficiency of the VN as compared with the JN.
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