In Line Aerosol Nebulization With High Flow

About

Brief Summary

The objective of ILAN is to assess the safety, feasibility and bronchodilator efficacy of in-line bronchodilator nebulizer delivery with VMN via HFNC system in hypoxemic respiratory failure patients treated with bronchodilators and compare this method to standard-nebulization using a jet nebulizer with a facial mask. The investigators hypothesized that aerosol nebulization using HFNC/VMN represents safer and more convenient approach in hypoxemic respiratory failure patients in comparison to conventional therapy while providing similar bronchodilator efficacy.

Primary Purpose

Supportive care

Study Type

Interventional

Phase

N/A

Eligibility

Gender

All

Healthy Volunteers

No

Minimum Age

18 Years

Maximum Age

N/A

Inclusion Criteria:

Adults ≥ 18 years of age
Patients with mild or moderate hypoxemic respiratory failure (with or without acute hypercapnic respiratory failure) treated with HFNC.
Nebulizer therapy ordered by the primary team with at least one dose delivered prior to the enrollment into the study
Patients must be on ordered nebulized albuterol, levalbuterol, ipratropium or ipratropium/albuterol combination with a maximum of Q3 or a minimum of Q6 hour frequencies.
For Respiratory Therapists: They must be employees of SMICU or RRMC.

Exclusion Criteria:

Lack of hypoxemia defined as SpO2> 92% on room air
Severe hypoxemia defined by PaO2/FiO2<100 or SpO2<92% on HFNC settings: ≥ FiO2 80% or higher and O2 flow 40L/min
HFNC O2 delivery via tracheostomy
COVID-19 positive status (within 3 weeks prior to the enrollment)
Respiratory distress, defined by respiratory rate > 24 breath per minute
Hemodynamic instability defined by the use of two or more vasopressor medications
Presence of nasal obstruction that may pose a risk for inadequate nebulizer delivery in the opinion of the investigator
Pulmonary comorbidities that, in the opinion of the investigator or clinical team, can pose a risk to subject safety or interfere with the subject's ability to complete the study procedures.
Moribund patient not expected to survive >24 hours
Inability to obtain informed consent from patient
Respiratory therapists who are unwilling to participate.