In Line Aerosol Nebulization With High Flow
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.
- 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.
- 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.