Role of Aerogen Nebulization in High Flow Oxygen Therapy

Role of Aerogen Nebulization in High Flow Oxygen Therapy

Overview

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  • Source: Aerogen

  • Date: 02 Oct,2020

High flow oxygen therapy is a form of respiratory support used in the hospital where oxygen, often in conjunction with compressed air and humidification, is delivered to a patient at rates of flow higher than that delivered traditionally in oxygen therapy.

High flow oxygen therapy is intended to

Eliminate most of the anatomic dead space Create a reservoir with high FiO2 in the nasal cavity
Improve gas exchange Significantly reduce the work of breathing High flow oxygen therapy can minimize the inspiratory resistance associated with the nasopharynx by providing nasopharyngeal gas flows that match or exceed a patient’s peak inspiratory flow. The resulting reduction in resistance translates into a decrease in resistive work of breathing.

Nebulized drug administration during high flow oxygen therapy helps you improve therapy efficiency, for example in cases of bronchospasm or chronic hypercapnia.

Aerosol therapy during the use of High Flow Nasal Cannula (HFNC) can be provided by the Aerogen Solo in line with a variety of HFNC systems, delivering aerosol directly through the nasal cannula. This technique allows aerosol delivery without interruption of oxygen flow and pressure and is more effective than placement of an aerosol mask over the nasal cannula. Preliminary studies have demonstrated sub-optimal delivery of aerosol with the placement of aerosol masks over the cannula compared to taking the cannula off to administer aerosol therapy.

Initial studies have demonstrated that the Aerogen Solo can provide effective aerosol therapy through the cannula of a HFNC system7, 31, 32. Ari et al. studied aerosol delivery in paediatric patients and showed that an inhaled dose of 11% was achievable at a gas flow rate of 3L/min. The effect of flow and gas type does modify the aerosol deposition where heliox and lower flow rates have a favourable effect on aerosol dose. More recent research into adult HFNC showed that placing the

Aerogen Solo before the humidifier provided optimal aerosol therapy in comparison to two small volume nebulisers.

Reminiac at al. commented that the Aerogen Solo “was associated with high nebulisation efficiency, a high fraction of aerosol made of particle with a diameter of 0.4 to 4.4 μm, a shorter nebulisation duration, and the absence of added gas flow” which could potentially influencing the inspired oxygen fraction8.

A lung dose of between 2-10% were achieved at flows rates 30, 45, and 60 L/min and aerosol delivered was greater with distressed breathing than with normal breathing.

Aerogen Solo – Aerosol drug delivery nebulizer for single patient use:

  1. A real first in the field of precision aerosol drug delivery, the Aerogen Solo is redefining respiratory patient treatment for healthcare professionals worldwide.
  2. 4 times more medication delivered to patients lungs
  3. Quick & easy to set-up with no added flow
    Silent operation
  4. Suitable for solutions, suspensions, proteins and peptides
  5. Powered by the Aerogen Pro-X Controller for continuous use or the Aerogen USB Controller for intermittent use or powered by the built-in controller with many leading HFNC / NIV manufactures including F&P, ResMed etc..

Aerogen provides superior aerosol therapy within the intensive care environment during ventilation, NIV, HFNC and with spontaneously breathing patients. In addition to the optimal performance, substantial cost savings have also been acknowledged when hospitals make the transition to the device.

Note: The Article is compiled by Kamal Kishore, Business Manager, Aerogen India

References:

  1. Ari A, Atalay OT, Harwood R, Sheard MM, Aljamhan EA and Fink JB. Influence of nebulizer type, position, and bias flow on
    aerosol drug delivery in simulated pediatric and adult lung models during mechanical ventilation. Respiratory care. 2010;55:845-51.
  2. Berlinski A and Willis JR. Albuterol delivery by 4 different nebulizers placed in 4 different positions in a pediatric ventilator in vitro model. Respiratory care. 2013;58:1124-33.
  3. Fang TP, Lin HL, Chiu SH, Wang SH, DiBlasi RM, Tsai YH and Fink JB. Aerosol Delivery Using Jet Nebulizer and Vibrating Mesh Nebulizer During High Frequency Oscillatory Ventilation: An In Vitro Comparison. Journal of aerosol medicine and pulmonary drug delivery. 2016.
  4. Abdelrahim ME, Plant P and Chrystyn H. In-vitro characterisation of the nebulised dose during non-invasive ventilation. The Journal of pharmacy and pharmacology. 2010;62:966-72.
  5. Galindo-Filho VC, Ramos ME, Rattes CS, Barbosa AK, Brandao DC, Brandao SC, Fink JB and de Andrade AD. Radioaerosol Pulmonary Deposition Using Mesh and Jet Nebulizers During Noninvasive Ventilation in Healthy Subjects. Respiratory care. 2015;60:1238-46.
  6. McPeck M. Improved Aerosol Drug Delivery with an Electronic Mesh Nebulizer during Non-invasive Ventilation AARC poster. 2012
    Ari A, Harwood R, Sheard M, Dailey P and Fink JB. In vitro comparison of heliox and oxygen in aerosol delivery using pediatric high flow nasal cannula. Pediatric pulmonology. 2011;46:795-801.
  7. Reminiac F, Vecellio L, Heuze-Vourc’h N, Petitcollin A, Respaud R, Cabrera M, Le Pennec D, Diot P and Ehrmann S. Aerosol Therapy in Adults Receiving High Flow Nasal Cannula Oxygen Therapy. Journal of aerosol medicine and pulmonary drug delivery. 2015.
  8. Alcoforado L, de Melo Barcelar J, Castor Galindo V, Cristina S. Brandão S, Fink J, B. and Dornelas de Andrade A. Analysis of Deposition
  9. Radioaerosol Nebulizers Membrane in Healthy Subjects. ISAM poster presentation 2015.
  10. Ari A, Areabi H and Fink JB. Respiratory care. 2010;55:837-44.
  11. 1Ari A, Atalay OT, Harwood R, Sheard MM, Aljamhan EA and Fink JB. Respiratory care. 2010;55:845-51.

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