Table 1.
Clinical studies using trans-nasal aerosol delivery via HFNC in adults and children
| Author, year | Study type | Patient | Inhaled medication | Comparison | Finding |
|---|---|---|---|---|---|
| Bräunlich and Wirtz 2018 [9] | RCT crossover | Adults: 26 stable COPD | Salbutamol 2.5 mg + ipratropium 0.5 mg | JN via HFNC at 35 L/min vs JN alone | FEV1 change: 9.4 ± 13.6 vs 11.1 ± 17.2%, p = 0.5 |
| Réminiac et al., 2018 [10] | RCT crossover | Adults: 25 stable patients with reversible airflow obstruction | 2.5 mg albuterol | VMN via HFNC at 30 L/min vs JN with mask | FEV1 improvement: 0.33 (0.14, 0.39) vs 0.35 (0.18, 0.55) L, p = 0.11 |
| Madney et al., 2019 [11] | RCT crossover | Adults: 12 stable COPD | 5 mg salbutamol | VMN via HFNC at 5 L/min vs JN via HFNC | Urinary salbutamol excretion at 30 min and 24 h were higher with VMN than JN via HFNC (p < 0.05) |
| Li et al., 2019 [12] | Prospective dose response study | Adults: 42 stable asthma and COPD patients | Albuterol at an escalating dose of 0.5, 1.5, 3.5, and 7.5 mg | VMN via HFNC at 15–20 L/min vs MDI+Spacer | FEV1 increment at cumulative dose of 1.5 mg via HFNC was similar to 400 mcg albuterol via MDI+Spacer: 0.34 ± 0.18 vs. 0.34 ± 0.12 L, p = 0.878 |
| Ammar et al., 2018 [13] | Retrospective | Adults: 29 patients with hypoxemia and PH | Epoprostenol | VMN via HFNC at 39 ± 11 L/min | PaO2/FIO2 improvement of 60 ± 50 mmHg |
| Li et al., 2019 [14] | Retrospective | Adults: 11 ICU refractory hypoxemia patients comorbid with PH and/or RVD | Epoprostenol | VMN via HFNC at 35–40 L/min | 45.5% had SpO2/FIO2 improvement > 20% |
| Li et al., 2020 [15] | Retrospective Cohort comparison | Adults: 51 ICU patients with PH and/or RVD | Epoprostenol | VMN via HFNC at constant flow (n = 26) vs flow titrated based on individual response to inhaled epoprostenol (n = 25) | The percentage of patients who met the criteria for a positive response was higher in the flow titration group compared to the group with constant flow (85.7% vs. 50%, p = 0.035). |
| Morgan et al., 2015 [16] | Retrospective | Pediatrics: 5 infants acute bronchiolitis with respiratory distress | Albuterol | VMN via HFNC at 5–8 L/min vs JN and face mask | Compared to JN with mask, HR increment was higher after inhaling albuterol with VMN via HFNC; patient agitation was improved |
| Valencia-Ramos et al., 2018 [17] | RCT crossover | Pediatrics: 6 infants with bronchiolitis | Albuterol | VMN via HFNC around 8 L/min vs JN with mask | Increased level of comfort and satisfaction |
| Al-Subu et al., 2020 [18] | Retrospective | Pediatrics: 28 children with asthma or bronchiolitis | Albuterol | VMN via HFNC at 2–4 L/min vs VMN with mask | HR increased by 9.98 (95% CI 3.72–16.2) with VMN via HFNC vs 0.64 (95% CI, 1.65–2.93) beats/min with VMN via mask (p < 0.001) |
| Baudin et al., 2017 [19] | Retrospective | Pediatrics: 39 status asthmaticus (10 had severe acidosis at admission) | Albuterol | VMN via HFNC at maximum 1 L/kg/min vs standard oxygen without HFNC | In HFNC group, HR (165 ± 21 vs. 141 ± 25/min, p < 0.01) and RR (40 ± 13 vs. 31 ± 8/min, p < 0.01) decreased, and blood gas improved in the first 24 h |
HFNC high-flow nasal cannula, JN jet nebulizer, FEV1 forced expiratory volume at the first second, COPD chronic obstructive pulmonary disease, MDI metered dose inhaler, RCT randomized controlled trial, VMN vibrating mesh nebulizer, PH pulmonary hypertension, RVD right ventricular dysfunction, HR heart rate, RR respiratory rate, PaO2 partial pressure of arterial oxygen, SpO2 peripheral capillary oxygen saturation, FIO2 fraction of inspired oxygen, CI confidence interval