Aerosol Therapy during Noninvasive Ventilatory Support

Abstract

Noninvasive ventilation (NIV) and high flow nasal therapy (HFT) are increasingly used in intensive care units. Patients undergoing these respiratory supports often require inhaled therapies, mainly bronchodilators. The principles of aerosol practice in intubated patients in part apply to NIV. Aerosol therapy may nevertheless be challenging because of spontaneous non-controlled breathing and the noninvasive interfaces used.

Bench studies evaluating aerosol therapy during NIV show that, with single limb circuits, a greater amount of aerosol is delivered when the aerosol generator is placed between the leak port and the patient. Bench studies of HFT, mainly in pediatric models, show encouraging results, provided that the aerosol generator is positioned closed to the humidification chamber.

Clinical studies, only available for NIV, show that significant drug amounts are delivered to the lungs of healthy subject. In patients with obstructive lung disease, significant bronchodilation has been observed after bronchodilator nebulization in the NIV circuit. It is therefore feasible to practice aerosol therapy during NIV in the clinical setting. Some studies even suggested an additive or even synergistic effect of both therapies. If confirmed, those results may trigger specific NIV delivery in order to improve therapeutic efficacy of inhaled drugs. Bench results of aerosol therapy during HFT need to be confirmed in the clinical setting.