Abstract
Background:
Aerosol delivery via high-flow nasal cannula (HFNC) has gained popularity, due to the nasal interface's comfort and continuous trans-nasal pulmonary delivery of aerosolized medication. Various HFNC devices are available in the US, however, the aerosol delivery with different HFNC devices remains unclear. Thus, this study aimed to investigate the impact of different devices on trans-nasal aerosol delivery.
Methods:
A two-chamber model lung was connected to one chamber of an adult manikin with anatomically correct upper airway proportions, while the other chamber was connected to a critical care ventilator to simulate spontaneous breathing. A large-size nasal cannula was placed at the nasal prongs of the manikin, four HFNC devices (Vapotherm, Respironics V60, Hamilton C-1, Airvo2) with four flow settings were compared, with a vibrating mesh nebulizer (Solo, Aerogen) placed at the humidifier. 3 mL of albuterol (2.5mg/3mL) was used in each run (n = 5). The collection filter was placed between the manikin and the model lung. The drug was eluted from the filter and assayed with UV spectrophotometry (276 nm). Statistical test used was Kruskal Wallis.
Results:
Among the four HFNC devices, the Hamilton C1 delivered the highest inhaled dose, regardless of the flow settings. At low flow settings (10-20 L/min), the inhaled dose between Hamilton C1 and Airvo2 were comparable, while at high flow settings (40-60 L/min), inhaled dose with Hamilton C1 was 2-3 times of Airvo2 and V60. Aerosol delivery with Vapotherm was negligible (1-2.5%). In all devices, the inhaled dose decreases as the flow increases.
Conclusions:
Hamilton C1 and Airvo2 had similar inhaled doses with flow at 10-20 L/min, Hamilton C1 generated 2-3 times higher inhaled dose than Airvo2 and V60 with flow at 40-60 L/min, and aerosol delivery via Vapotherm should be avoided.
Table 1. inhaled dose for different devices during trans-nasal aerosol delivery
Flow (L/min)
Inhaled dose (%) of different HFNC devices, Mean SD
P value
Airvo2
V60
Vapotherm
Hamilton C1
5 (L/min)
N/A
N/A
2.5 ± 0.4
N/A
10 (L/min)
15.0 ± 1.2
8.5 ± 0.8
1.8 ± 0.3
16.8 ± 0.6
0.001
20 (L/min)
12.8 ± 1
6.4 ± 0.3
1.5 ± 0.1
13.5 ± 0.4
0.001
40 (L/min)
3.7 ± 0.5
5.1 ± 0.3
0.9 ± 0.5
10.9 ± 0.5
< 0.001
60 (L/min)
2.2 ± 0.2
N/A
N/A
8.8 ± 0.3
0.009
80 (L/min)
1.7 ± 0.7
Figure 1. experiment set-up
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