In Vitro Evaluation of Aerosol Delivery via a New High-Flow Nasal Cannula Device in Adult, Toddler, and Neonate Models.

Abstract

<h4>Background</h4>Nebulization through high-flow nasal cannula (HFNC) is increasingly used for aerosolized medication across various age groups. This study compared the aerosol delivery performance of a new HFNC device (O2FLO) with the Airvo 2 in simulated adult, toddler, and neonate models.<h4>Methods</h4>Albuterol sulfate (2.5 mg/3 mL) was administered using a vibrating mesh nebulizer placed in line at the humidifier inlet for O2FLO or outlet for Airvo 2. Two circuit types were tested with the O2FLO device; the integrated heated breathing circuit and the embedded heated breathing circuit. Flow settings were set to represent low- (0.5 times peak inspiratory flow) and high-flow (1.5 times) conditions: 15 and 45 L/min for adults, 5 and 15 L/min for toddlers, and 2 and 6 L/min for neonates. Conventional nebulization using a jet nebulizer or a vibrating mesh nebulizer with an aerosol mask was included for comparison. Delivered dose was quantified by assaying the drug deposited on a filter placed at the trachea of each model using ultraviolet spectrophotometry (276 nm).<h4>Results</h4>Across all models, in-line vibrating mesh nebulizer delivered higher delivered doses at low flow compared to high flow (all <i>P</i> < .05). O2FLO with integrated heated breathing circuit consistently outperformed the embedded circuit and, at low flow, achieved higher delivered dose than Airvo 2 in toddler and neonate models (all <i>P</i> < .05). Compared to conventional nebulization, in-line aerosol delivery with HFNC at low flow yielded greater delivered doses in adult and toddler models (all <i>P</i> < .05). At high flow, delivered doses were lower than those from vibrating mesh nebulizer with a mask in all models but remained higher than those from jet nebulizer with a mask in toddler and neonate models (all <i>P</i> < .05).<h4>Conclusions</h4>In-line nebulization using the O2FLO device with an integrated heated breathing circuit outperformed the embedded circuit. At lower flow, the integrated circuit delivered higher delivered doses than conventional nebulization methods in adult and toddler models.