title: Comparison of HFNC, bubble CPAP and SiPAP on aerosol delivery in neonates: An in-vitro study.
abstract: 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.
  
  
  OBJECTIVE
  The purpose of this study was to compare aerosol delivery via HFNC, bubble CPAP, and SiPAP in a model of a simulated spontaneously breathing preterm infant.
  
  
  OBJECTIVE
  The types of CPAP systems and nebulizer positions used during aerosol therapy will impact aerosol deposition in simulated spontaneously breathing infants.
  
  
  METHODS
  Quantitative, comparative, in-vitro study.
  
  
  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 via collecting filter distal to the trachea. The HFNC (Optiflow; Fisher & Paykel), Bubble CPAP (Fisher & Paykel), and SiPAP (Carefusion) were attached to the nares of the model via each device's proprietary nasal cannula and set to deliver a baseline of 5 cm H2 O 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 one-way analysis of variance (ANOVA), with P < 0.05 significant.
  
  
  RESULTS
  At position 1, the trend of lower deposition (mean ± SD%) across devices was not significant (0.90 ± 0.26, 0.70 ± 0.16 and 0.59 ± 0.19, respectively; P = 0.098); however, in position 2, drug delivery with SiPAP (0.79 ± 0.11) was lower compared to both HFNC (1.30 ± 0.17; P = 0.003) and bubble CPAP (1.24 ± 0.24; p = 0.008). Placement of the nebulizer prior to the humidifier increased deposition with all devices (P < 0.05).
  
  
  CONCLUSIONS
  Aerosol can be delivered via all three devices used in this study. Device selection and nebulizer position impacted aerosol delivery in this simulated model of a spontaneously breathing preterm infant.
authors.affiliation: Georgia State University, Division of Respiratory Therapy, Atlanta, Georgia.
authors.forename: Fatemah S
authors.initials: FS
authors.lastname: Sunbul
authors.affiliation: Georgia State University, Division of Respiratory Therapy, Atlanta, Georgia.
authors.forename: James B
authors.initials: JB
authors.lastname: Fink
authors.affiliation: Georgia State University, Division of Respiratory Therapy, Atlanta, Georgia.
authors.forename: Robert
authors.initials: R
authors.lastname: Harwood
authors.affiliation: Georgia State University, Division of Respiratory Therapy, Atlanta, Georgia.
authors.forename: Meryl M
authors.initials: MM
authors.lastname: Sheard
authors.affiliation: Georgia State University, Division of Respiratory Therapy, Atlanta, Georgia.
authors.forename: Ralph D
authors.initials: RD
authors.lastname: Zimmerman
authors.affiliation: Georgia State University, Division of Respiratory Therapy, Atlanta, Georgia.
authors.forename: Arzu
authors.initials: A
authors.lastname: Ari
mesh_terms: D000336:Aerosols / Q000008:administration & dosage*; D000420:Albuterol / Q000008:administration & dosage*; D057785:Catheters; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008953:Models, Anatomic; D009330:Nebulizers and Vaporizers; D012119:Respiration / Q000187:drug effects*
chemical_list: D000336:Aerosols; D000420:Albuterol
keywords: Aerosols; SiPAP; bubble CPAP; continuous positive airway pressure; high flow nasal cannula; nebulizer; neonate