Impact of Gas Flow and Humidity on Trans-Nasal Aerosol Deposition via Nasal Cannula in Adults: A Randomized Cross-Over Study

Luciana Alcoforado, Arzu Ari, Jacqueline de Melo Barcelar, Simone Cristina S Brandão, James B Fink, Armele Dornelas de Andrade, Luciana Alcoforado, Arzu Ari, Jacqueline de Melo Barcelar, Simone Cristina S Brandão, James B Fink, Armele Dornelas de Andrade

Abstract

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 (NCT02519465).

Keywords: aerosol; humidity; nasal cannula; oxygen and nebulizer; scintigraphy.

Conflict of interest statement

The authors declare no conflict of interest. The co-author James B. Fink is CSO of Aerogen Pharma Corp. The company had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
High flow nasal cannula system consisting of compressed oxygen cylinder with regulator and pressure compensated flowmeter, connecting to a T-piece with vibrating mesh nebulizer attached to the inlet of the humidifier chamber, with the outlet connected to a heated wire circuit attached to a nasal cannula and placed in the nares of the subject. A mask with a collecting filter was placed over the face and cannula to collect exhaled and escaped aerosol.
Figure 3
Figure 3
Representative images of pulmonary deposition with heated humidified LFNC at 10 L/min and HFNC at 30 L/min and 50 L/min.
Figure 4
Figure 4
Aerosol distribution across compartments with LF and HFNC during heated humidified (H) and unheated (U) at flows of 10, 30, and 50 L/min.

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