Impact of Gas Flow and Humidity on Trans-Nasal Aerosol Deposition via Nasal Cannula in Adults: A Randomized Cross-Over Study
Impact of Gas Flow and Humidity on Trans-Nasal Aerosol Deposition via Nasal Cannula in Adults: A Randomized Cross-Over Study
复制标题
DOI：
10.3390/pharmaceutics11070320
复制
发表时间：
2019-07-01
期刊：
影响因子：
5.4
通讯作者：
de Andrade, Armele Dornelas
中科院分区：
文献类型：
--
作者：
Alcoforado, Luciana;Ari, Arzu;de Andrade, Armele Dornelas
背景资料：描述了使用高流量鼻插管（HFNC）装置的经鼻肺气雾剂递送，其具有超过患者吸气流量（HF）的高气体流量和较低流量（LF）的施用。该初步临床试验的目的是比较在主动加热加湿的情况下，通过鼻插管输送的三种气体流速下，放射性标记气雾剂在健康成人中的沉积和分布，并进一步确定在不加热加湿的情况下气雾剂给药的影响。研究方法：将23名健康成人（16 F）随机分配接受主动加热湿化或未加热氧气的气雾剂，气体流量为10 L/min（n = 8）、30 L/min（n = 7）或50 L/min（n = 8）。将标记有1毫居里（37 MBq）锝-99m（DTPA-Tc 99 m）的二亚乙基三胺五乙酸与NaCl混合至1 mL填充体积，并通过放置在湿化器入口处的网状雾化器给药。使用伽马照相机进行放射性计数，并使用来自肺、上气道、胃、雾化器、回路和呼气过滤器的计数来界定感兴趣区域（ROI）。计算质量平衡，并将每个隔室表示为总量的百分比。结果如下：10 L/min加热湿化气体的肺沉积（平均值+/- SD）大于30 L/min或50 L/min（分别为17.2 +/-6.8%、5.71 +/-2.04%和3.46 +/-1.24%; p = 0.0001）。使用未加热的载气，在10 L/min时，气雾剂的肺剂量与主动加热加湿条件相似，但在30和50 L/min时更大（p = 0.011）。给药气体流量与肺沉积量呈负相关（r =-0.880，P < 0.001）。结论：流量和主动加热湿度都对通过HFNC的气溶胶输送产生相反影响。然而，在健康成人受试者中，在常用流量范围内进行气雾剂给药可提供可测量的肺沉积水平（NCT 02519465）。
Background: Trans-nasal pulmonary aerosol delivery using high flow nasal cannula (HFNC) devices is described with the administration of high gas flows exceeding patient inspiratory flow (HF) and with lower flows (LF). The aim of this pilot clinical trial was to compare deposition and distribution of radiolabeled aerosol via nasal cannula in healthy adults across three rates of gas flow delivered with active heated humidification, and to further identify the impact of aerosol administration without heated humidity. Methods: Twenty-three (23) healthy adults (16F) were randomized to receive aerosol with active heated humidification or unheated oxygen at gas flows of 10 L/min (n = 8), 30 L/min (n = 7), or 50 L/min (n = 8). Diethylenetriaminepentaacetic acid labeled with 1 millicurie (37 MBq) of Technetium-99m (DTPA-Tc99m) was mixed with NaCl to a fill volume of 1 mL, and administered via mesh nebulizer placed at the inlet of the humidifier. Radioactivity counts were performed using a gamma camera and the regions of interest (ROIs) were delimited with counts from the lungs, upper airways, stomach, nebulizer, circuit, and expiratory filter. A mass balance was calculated and each compartment was expressed as a percentage of the total. Results: Lung deposition (mean +/- SD) with heated humidified gas was greater at 10 L/min than 30 L/min or 50 L/min (17.2 +/- 6.8%, 5.71 +/- 2.04%, and 3.46 +/- 1.24%, respectively; p = 0.0001). Using unheated carrier gas, a lung dose of aerosol was similar to the active heated humidification condition at 10 L/min, but greater at 30 and 50 L/min (p = 0.011). Administered gas flow and lung deposition were negatively correlated (r = -0.880, p < 0.001). Conclusions: Both flow and active heated humidity inversely impact aerosol delivery through HFNC. Nevertheless, aerosol administration across the range of commonly used flows can provide measurable levels of lung deposition in healthy adult subjects (NCT 02519465).