Abstract
Background:
Nebulized albuterol and heated high flow nasal cannula systems (HHFNC) are commonly used to treat pediatric patients in respiratory distress. Data are available with adult and infant models but not with older pediatric models. Nebulization could be given in-line with HFNC circuit or via a face mask. We hypothesize that drug delivery will decrease with increasing flow through HFNC.
Methods:
An anatomically correct oronasotracheal model of a 5 year old child (average weight = 18 kg) was connected in series to a filter, and a breathing simulator (tidal volume 200 mL, respiratory rate 20, and inspiration time 0.9s). A Fisher Paykel Optiflow Junior 2 XL cannula with heated-wired circuit (ID=13mm) was used. A vibrating mesh nebulizer (VMN) was placed on the dry side of the humidifier, and the HFNC was run at 5, 10, 15, and 20 L/min. A continuous output jet nebulizer (JN) (6 L/min) was connected to a tightly fit face mask with the HFNC was run at 0, 5, 8, 10, 15 L/min. Ten mg of albuterol were loaded in VMN (2ml) and the JN (4.5ml). 4 units of VMN and JN were used, and run till sputtering occurred. Albuterol mass was measured via spectrophotometer, and reported as percentage of loading dose.
Results:
See table.
Conclusions:
Albuterol deposition decreases with increasing flow through HFNC for both VMN and JN. Oronasal delivery of albuterol via face mask is impaired by concomitant use of HFNC.
ap=0.08 compared to 10 L/min. bp<0.001 compared to 15 or 20 L/min. Cp<0.05 compared to 5 L/min. dp<0.001 compared to 8, 10 or 15 L/min. View all access options for this article.Results (%lung deposition)
Flow (l/min)
0
5
8
10
15
20
VMN
--
11.9±0.8ab
--
10.6±1.2b
5.2±0.7
2.4±0.6
JN
5.9±0.5cd
2.6±0.5d
0.7±0.2
--
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