Comparison of Aerosol Delivery of a Standard Nebulizer With a T-Piece vs Nebulizing Using a Y-Piece Simultaneous With High-Flow Oxygen Therapy

Abstract

Background:

Patients with tracheostomies are often required to be medically treated with high flow oxygen therapy as well as nebulized medication. ConMed Corporation’s MUNODA Universal Respiratory Adapter (Utica, NY) allows healthcare providers to eliminate the need to disconnect high flow oxygen by delivering both inhaled medication and high flow oxygen to the patient simultaneously. The purpose of this research is to determine if using this adapter impacts the amount of medication delivered to the airway. We hypothesized that there would be no difference in solute deposition between using the MUNODA Universal Respiratory Adapter (Y-tube adapter) combining a high flow device and nebulizer versus a traditional treatment delivered via aerosolized nebulizer alone to deliver nebulized medication.

Methods:

A simulated patient with a 7.0mm Shiley Tracheostomy Tube (Tyco Healthcare, Minneapolis,MN) was ventilated by a Hans Rudulph Series 1101 Breathing Simulator (Shawnee Mission, KS) utilizing a normal breathing pattern. For the trials with the Y-piece-tube adapter, a Salter Labs NebuTech HDN nebulizer (Arvin, CA) and a Carefusion Venturi high flow device (San Diego, CA) were attached to the Munoda y-tube. The y-tube was then attached to the trach via a t-piece with an exhalation port using large bore tubing measuring one link. A Teleflex Bacterial/Viral Filter (Morrisville, NC) was attached to the airway and connected via large bore tubing to the breathing simulator. A 3-mL solution of 10% hypertonic saline solution was nebulized for 4 minutes. The Venturi device was set to deliver a total flow of 32 L/min. For the trials without the Y-piece-tube adaptor, a nebulizer was placed directly into the t-piece. Each filter was weighed before and after the treatment was given, and the difference was recorded. Each trial was performed in triplicate.

Results:

The average change in weight of the filters following nebulization utilizing the Y-piece adapter and high flow O₂ was 26.7 mg, and the nebulizer alone was 70 mg. The difference in weight between the two trials was significant (P = .015).

Conclusions:

Based on the results from these trials, using the Munoda adapter with high flow O₂ delivered significantly less aerosol than the T piece method. We discovered an incidental finding; when the nebulizer and high flow Venturi were used with the Y- piece, it generated less visible aerosol than when the nebulizer was used alone.