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Abstract
BACKGROUND: Whereas high-flow nasal cannula (HFNC) oxygen therapy is increasingly used in patients with exacerbation of COPD, the effectiveness of β2 agonist nebulization through HFNC has been poorly assessed. We hypothesized that salbutamol vibrating-mesh nebulization through HFNC improves pulmonary function tests in subjects with COPD.
METHODS: We conducted a physiological crossover study including subjects admitted to the ICU for severe exacerbation of COPD. After subject improvement allowing a 3-h washout period without bronchodilator, pulmonary function tests were performed while breathing through HFNC alone and after salbutamol vibrating-mesh nebulization through HFNC. The primary end point consisted in the changes in FEV1 before and after salbutamol nebulization. Secondary end points included the changes in FVC, peak expiratory flow (PEF), airway resistance, and clinical parameters.
RESULTS: Among the 15 subjects included, mean (SD) FEV1 significantly increased after salbutamol nebulization from 931 mL (383) to 1,019 (432), mean difference +87 mL (95% CI 30–145) (P = .006). Similarly, FVC and PEF significantly increased, +174 mL (95% CI 66–282) (P = .004) and +0.3 L/min (95% CI 0–0.6) (P = .037), respectively. Airway resistances and breathing frequency did not significantly differ, whereas heart rate significantly increased after nebulization.
CONCLUSIONS: In subjects with severe exacerbation of COPD, salbutamol vibrating-mesh nebulization through HFNC induced a significant bronchodilator effect with volume and flow improvement.
Footnotes
- Correspondence: Jean-Pierre Frat MD PhD, Médecine Intensive Réanimation, Centre hospitalier universitaire de Poitiers, 2 rue de la Milétrie, CS 90577, 86021 Poitiers Cedex. E-mail: jean-pierre.frat{at}chu-poitiers.fr
See the Related Editorial on Page 149
The study was performed at intensive care of Poitiers University Hospital: CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France.
The study received a grant from Le nouveau souffle.
The study was registered on ClinicalTrial.gov: NCT03449056.
Dr Frat discloses relationships with the French Ministry of Health, Fisher & Paykel Healthcare, and SOS Oxygène. Dr Thille discloses relationships with the French Ministry of Health, Fisher & Paykel Healthcare, Maquet Getinge, GE Healthcare, and Covidien. Dr Marjanovic discloses a relationship with Fisher & Paykel. The remaining authors have no conflicts to disclose.
- Copyright © 2022 by Daedalus Enterprises
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