Aerosol delivery through high flow nasal cannula compared to biphasic positive airway pressure, at two different pressure: an in-vitro study

Abstract Background Both non-invasive ventilation and high flow oxygen therapy are preferred over low flow oxygen therapy in many conditions. Nebulizers, for aerosol delivery, can be used within them without interrupting the circuit. The present study aimed to compare the efficiency of drug delivery...

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Autores principales:	Marina E. Boules, Nabila Ibrahim Laz, Ahmed A. Elberry, Raghda R. S. Hussein, Mohamed E. A. Abdelrahim
Formato:	article
Lenguaje:	EN
Publicado:	SpringerOpen 2021
Materias:	Oxygen therapy Nasal cannula Biphasic positive airway pressure Inspiratory pressure Medicine (General) R5-920 Science Q
Acceso en línea:	https://doaj.org/article/7442544856f74d439676c664ddfaf113
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spelling	oai:doaj.org-article:7442544856f74d439676c664ddfaf1132021-11-21T12:28:36ZAerosol delivery through high flow nasal cannula compared to biphasic positive airway pressure, at two different pressure: an in-vitro study10.1186/s43088-021-00169-w2314-8543https://doaj.org/article/7442544856f74d439676c664ddfaf1132021-11-01T00:00:00Zhttps://doi.org/10.1186/s43088-021-00169-whttps://doaj.org/toc/2314-8543Abstract Background Both non-invasive ventilation and high flow oxygen therapy are preferred over low flow oxygen therapy in many conditions. Nebulizers, for aerosol delivery, can be used within them without interrupting the circuit. The present study aimed to compare the efficiency of drug delivery within high flow nasal cannula (HFNC) and biphasic positive airway pressure (BiPAP) ventilation mode using two different inspiratory positive airway pressures. The aerosol delivery was examined in HFNC system at low flow, 5 L min−1, and BiPAP non-invasive ventilation under 2 different pressures [high pressure; inspiratory positive airway pressure/expiratory positive airway pressure (IPAP/EPAP) of 20/5 cm water, and low pressure; IPAP/EPAP of 10/5 cm water]. The total inhalable dose (TID) was measured by inserting an Aerogen Solo nebulizer installed with 1 mL salbutamol respiratory solution (5000 μg mL−1) within the circuit, and the salbutamol was collected on an inhalation filter placed in a filter holder connected to a breathing simulator. The breathing simulator was adjusted at a tidal volume of 500 mL, respiratory rate of 15 breaths min−1, and inhalation to exhalation (I:E) ratio of 1:1 for the adult setting. In each technique of the three (HFNC, and low, and high-pressures BiPAP), TID was determined 5 times (n = 5). For particle size characterization, cooled Anderson Cascade Impactor (ACI) was inserted instead of the inhalation filter and the breathing simulator with the same scheme. In each technique of the three, particle size characterization was determined 3 times (n = 3). Results The BiPAP mode at low inspiratory pressure had the highest TID, followed by HFNC at flow 5 L min−1, then BiPAP mode at high inspiratory pressure. There was a significant difference only between low and high inspiratory pressure modes of BiPAP mode. Low-inspiratory pressure BiPAP delivered the highest mean ± SD fine particle dose (FPD). It was significantly higher than that delivered in high inspiratory pressure BiPAP, and HFNC. Also, FPD in HFNC was significantly higher than that in high inspiratory pressure BiPAP. HFNC system had the smallest mass median aerodynamic diameter (MMAD) and the highest FPF followed by low then high inspiratory pressure BiPAP. Conclusions Increasing the inspiratory positive airway pressure in BiPAP, from 10 to 20 cm water, decreased the total inhalable dose and FPF nearly by half. Low inspiratory pressure BiPAP delivered the highest TID and FPD. The HFNC system at low oxygen flow resulted in the least MMAD, and the highest FPF. Using HFNC delivered a TID that was non-significant from that delivered by low inspiratory pressure BiPAP. Graphical AbstractMarina E. BoulesNabila Ibrahim LazAhmed A. ElberryRaghda R. S. HusseinMohamed E. A. AbdelrahimSpringerOpenarticleOxygen therapyNasal cannulaBiphasic positive airway pressureInspiratory pressureMedicine (General)R5-920ScienceQENBeni-Suef University Journal of Basic and Applied Sciences, Vol 10, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Oxygen therapy Nasal cannula Biphasic positive airway pressure Inspiratory pressure Medicine (General) R5-920 Science Q
spellingShingle	Oxygen therapy Nasal cannula Biphasic positive airway pressure Inspiratory pressure Medicine (General) R5-920 Science Q Marina E. Boules Nabila Ibrahim Laz Ahmed A. Elberry Raghda R. S. Hussein Mohamed E. A. Abdelrahim Aerosol delivery through high flow nasal cannula compared to biphasic positive airway pressure, at two different pressure: an in-vitro study
description	Abstract Background Both non-invasive ventilation and high flow oxygen therapy are preferred over low flow oxygen therapy in many conditions. Nebulizers, for aerosol delivery, can be used within them without interrupting the circuit. The present study aimed to compare the efficiency of drug delivery within high flow nasal cannula (HFNC) and biphasic positive airway pressure (BiPAP) ventilation mode using two different inspiratory positive airway pressures. The aerosol delivery was examined in HFNC system at low flow, 5 L min−1, and BiPAP non-invasive ventilation under 2 different pressures [high pressure; inspiratory positive airway pressure/expiratory positive airway pressure (IPAP/EPAP) of 20/5 cm water, and low pressure; IPAP/EPAP of 10/5 cm water]. The total inhalable dose (TID) was measured by inserting an Aerogen Solo nebulizer installed with 1 mL salbutamol respiratory solution (5000 μg mL−1) within the circuit, and the salbutamol was collected on an inhalation filter placed in a filter holder connected to a breathing simulator. The breathing simulator was adjusted at a tidal volume of 500 mL, respiratory rate of 15 breaths min−1, and inhalation to exhalation (I:E) ratio of 1:1 for the adult setting. In each technique of the three (HFNC, and low, and high-pressures BiPAP), TID was determined 5 times (n = 5). For particle size characterization, cooled Anderson Cascade Impactor (ACI) was inserted instead of the inhalation filter and the breathing simulator with the same scheme. In each technique of the three, particle size characterization was determined 3 times (n = 3). Results The BiPAP mode at low inspiratory pressure had the highest TID, followed by HFNC at flow 5 L min−1, then BiPAP mode at high inspiratory pressure. There was a significant difference only between low and high inspiratory pressure modes of BiPAP mode. Low-inspiratory pressure BiPAP delivered the highest mean ± SD fine particle dose (FPD). It was significantly higher than that delivered in high inspiratory pressure BiPAP, and HFNC. Also, FPD in HFNC was significantly higher than that in high inspiratory pressure BiPAP. HFNC system had the smallest mass median aerodynamic diameter (MMAD) and the highest FPF followed by low then high inspiratory pressure BiPAP. Conclusions Increasing the inspiratory positive airway pressure in BiPAP, from 10 to 20 cm water, decreased the total inhalable dose and FPF nearly by half. Low inspiratory pressure BiPAP delivered the highest TID and FPD. The HFNC system at low oxygen flow resulted in the least MMAD, and the highest FPF. Using HFNC delivered a TID that was non-significant from that delivered by low inspiratory pressure BiPAP. Graphical Abstract
format	article
author	Marina E. Boules Nabila Ibrahim Laz Ahmed A. Elberry Raghda R. S. Hussein Mohamed E. A. Abdelrahim
author_facet	Marina E. Boules Nabila Ibrahim Laz Ahmed A. Elberry Raghda R. S. Hussein Mohamed E. A. Abdelrahim
author_sort	Marina E. Boules
title	Aerosol delivery through high flow nasal cannula compared to biphasic positive airway pressure, at two different pressure: an in-vitro study
title_short	Aerosol delivery through high flow nasal cannula compared to biphasic positive airway pressure, at two different pressure: an in-vitro study
title_full	Aerosol delivery through high flow nasal cannula compared to biphasic positive airway pressure, at two different pressure: an in-vitro study
title_fullStr	Aerosol delivery through high flow nasal cannula compared to biphasic positive airway pressure, at two different pressure: an in-vitro study
title_full_unstemmed	Aerosol delivery through high flow nasal cannula compared to biphasic positive airway pressure, at two different pressure: an in-vitro study
title_sort	aerosol delivery through high flow nasal cannula compared to biphasic positive airway pressure, at two different pressure: an in-vitro study
publisher	SpringerOpen
publishDate	2021
url	https://doaj.org/article/7442544856f74d439676c664ddfaf113
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Aerosol delivery through high flow nasal cannula compared to biphasic positive airway pressure, at two different pressure: an in-vitro study

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