Background: Aerosol drug delivery via high flow nasal cannula (HFNC), bubble continuous positive airway pressure (CPAP), and synchronized inspiratory positive airway pressure (SiPAP) has not been quantified in spontaneously breathing premature infants. The purpose of this study was to compare HFNC, bubble CPAP, and SiPAP on aerosol delivery in a simulated spontaneously breathing preterm model.
Methods: A breath simulator was set to preterm infant settings (VT: 9 ml, RR: 50 bpm and Ti: 0.5 sec) and connected to the trachea of an anatomical upper airway model of a preterm infant (DiBlasi) via collecting filter distal to the trachea. The HFNC (Fisher & Paykel), Bubble CPAP (Fisher & Paykel), and SiPAP (Carefusion) were attached to the model via their proprietary nasal cannula and set to deliver 5 cm H2O pressure. Albuterol sulfate (2.5 mg/0.5 mL) was aerosolized with a mesh nebulizer (Aeroneb Solo) positioned (1) proximal to the patient and (2) prior to the humidifier (n=5).The drug was eluted from the filter with 0.1 N HCl and analyzed via spectrophotometry (276 nm). Data were analyzed using descriptive statistics, t-tests, and analysis of variance (ANOVA), with p
Results: At position 1, the trend of lower deposition across devices was not significant; however, in position 2, drug delivery with SiPAP was significantly lower compared to both HFNC (p=0.003) and bubble CPAP (p=0.008).Placement of the nebulizer prior to the humidifier increased deposition with all devices (p\u3c0.05).
Conclusion: Aerosol can be delivered via all three devices used in this study; however, delivery efficiency of HFNC is better than the other CPAP devices tested. Device selection and nebulizer position impacted aerosol delivery in this simulated model of a spontaneously breathing preterm infant
