Résumé
La ventilation non invasive (VNI), ainsi que les traitements par haut débit nasal humidifié (HDN), d’utilisation croissante en réanimation, s’adressent souvent à des patients nécessitant par ailleurs des traitements inhalés, principalement des bronchodilatateurs. Les principes établis pour l’aérosoltherapie chez le patient intubé s’appliquent en partie au cours de la VNI. L’aérosolthérapie peut néanmoins s’avérer plus difficile en raison du caractère spontané et non contrôlé de la ventilation et de par les interfaces non invasives utilisées. Les études sur banc ayant évalué l’aérosolthérapie au cours de la VNI rapportent, lors de l’utilisation de circuits monobranches, une meilleure efficacité quand le générateur d’aérosol est situé entre l’orifice de fuite et le patient. Les travaux sur banc au cours du HDN, principalement pédiatriques, sont encourageants, à condition que le générateur d’aérosol soit positionné au niveau de la chambre d’humidification. Les études cliniques, uniquement disponibles pour la VNI, montrent que des quantités significatives de médicament se déposent au niveau pulmonaire chez des volontaires sains. Chez des patients souffrant d’obstruction bronchique, un effet bronchodilatateur significatif a été observé après nébulisation de bronchodilatateurs dans le circuit de VNI. Il est donc possible de pratiquer l’aérosolthérapie par bronchodilatateurs au cours de la VNI. Certains travaux ont même suggéré un effet additif, voire synergique, des deux techniques. Si ces résultats se confirment, il pourra être envisagé de mettre en place un support par VNI pour une meilleure efficacité thérapeutique du traitement inhalé. Les résultats sur banc au cours de l’HDN demandent à être confirmés en clinique.
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.
Article PDF
Références
Demoule A, Girou E, Richard JC, et al (2006) Benefits and risks of success or failure of noninvasive ventilation. Intensive Care Med 32:1756–65
Demoule A, Chevret S, Carlucci A, et al (2015) Changing use of noninvasive ventilation in critically ill patients: trends over 15 years in francophone countries. Intensive Care Med [in press]
Struik FM, Sprooten RT, Kerstjens HA, et al (2014) Nocturnal non-invasive ventilation in COPD patients with prolonged hypercapnia after ventilatory support for acute respiratory failure: a randomised, controlled, parallel-group study. Thorax 69:826–34
Struik FM, Lacasse Y, Goldstein RS, et al (2014) Nocturnal noninvasive positive pressure ventilation in stable COPD: a systematic review and individual patient data meta-analysis. Respir Med 108:329–37
Köhnlein T, Windisch W, Köhler D, et al (2014) Non-invasive positive pressure ventilation for the treatment of severe stable chronic obstructive pulmonary disease: a prospective, multicentre, randomised, controlled clinical trial. Lancet Respir Med 2:698–705
Cabrini L, Landoni G, Oriani A, et al (2015) Noninvasive ventilation and survival in acute care settings: a comprehensive systematic review and meta-analysis of randomized controlled trials. Crit Care Med 43:880–8
Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2015) www.goldcopd.org (consulté le 28 septembre 2015)
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) (2015) www.ginasthma.org (consulté le 29 septembre 2015)
Lim WJ, Mohammed Akram R, Carson KV, et al (2012) Noninvasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbations of asthma. Cochrane Database Syst Rev 12:CD004360
Ryan G, Singh M, Dwan K (2011) Inhaled antibiotics for longterm therapy in cystic fibrosis. Cochrane database syst rev 3: CD001221
Mogayzel PJ, Naureckas ET, Robinson KA, et al (2013) Cystic fibrosis pulmonary guidelines. Chronic medications for maintenance of lung health. Am J Respir Crit Care Med 187:680–9
Fauroux B (2011) Why, when and how to propose noninvasive ventilation in cystic fibrosis. Minerv Anestesiol 77:1108–14
Moran F, Bradely JM, Piper AJ (2013) Non-invasive ventilation for cystic fibrosis. Cochrane Database Syst Rev 4:CD002769
Ehrmann S, Roche-Campo F, Sferrazza Papa GF, et al (2013) Aerosol therapy during mechanical ventilation: an international survey. Intensive Care Med 39:1048–56
Ehrmann S, Roche-Campo F, Bodet-Contentin L, et al (2015) Aerosol therapy in intensive and intermediate care units: prospective observation of 2808 critically ill patients. Intensive Care Med [in press]
Sztrymf B, Messika J, Mayot T, et al (2012) Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: a prospective observational study. J Crit Care 27:9–13
Frat JP, Thille AW, Mercat A, et al (2015) High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 372:2185–96
Bräunlich J, Seyfarth HJ, Wirtz H (2015) Nasal High-flow versus non-invasive ventilation in stable hypercapnic COPD: a preliminary report. Multidiscip Respir Med 10:27
Morgan SE, Mosakowski S, Solano P, et al (2015) High-Flow Nasal Cannula and Aerosolized β Agonists for Rescue Therapy in ChildrenWith Bronchiolitis: A Case Series. Respir Care 60:e161–5
Millar J, Lutton S, O’Connor P (2014) The use of high-flow nasal oxygen therapy in the management of hypercarbic respiratory failure. Ther Adv Respir Dis 8:63–4
Bräunlich J, Beyer D, Mai D, et al (2013) Effects of nasal high flow on ventilation in volunteers, COPD and idiopathic pulmonary fibrosis patients. Respiration 85:319–25
Ari A, Fink JB, Dhand R (2012) Inhalation therapy in patients receiving mechanical ventilation: an update. J Aerosol Med Pulm Drug Deliv 25:319–32
Ehrmann S, Guillon A, Mercier E, et al (2012) Administration d’aérosols médicamenteux au cours de la ventilation mécanique. Réanimation 21:42–54
Hess DR (2015) Aerosol Therapy During Noninvasive Ventilation or High-Flow Nasal Cannula. Respir Care 60:880–93
Ehrmann S, Lyazidi A, Louis B, et al (2014) Ventilator-integrated jet nebulization systems: tidal volume control and efficiency of synchronization. Respir Care 59:1508–16
Zainudin BM, Biddiscombe M, Tolfree SE, et al (1990) Comparison of bronchodilator responses and deposition patterns of salbutamol inhaled from a pressurized metered dose inhaler, as a dry powder, and as a nebulised solution. Thorax 45:469–73
Dhand R, Duarte AG, Jubran A (1996) Dose-response to bronchodilator delivered by metered-dose inhaler in ventilatorsupported patients. Am J Respir Crit Care Med 154:388–93
Mukhopadhyay A, Dela Pena E, Wadden B (2009) Effects of inhalational bronchodilator treatment during noninvasive ventilation in severe chronic obstructive pulmonary disease exacerbations. J Crit Care 24:474.e1–5
Smaldone GC, Messina MS (1985) Enhancement of particle deposition by flow-limiting segments in humans. J Appl Physiol 59:509–14
Elman M, Goldstein I, Marquette CH, et al (2002) Influence of lung aeration on pulmonary concentration of nebulized and intravenous amikacin in ventilated piglets with severe bronchopneumonia. Anesthesiology 97:199–206
Vignaux L, Vargas F, Roeseler J, et al (2009) Patient-ventilator asynchrony during non-invasive ventilation for acute respiratory failure: a multicenter study. Intensive Care Med 35:840–6
Everard ML, Hardy JG, Milner AD (1993) Comparison of nebulized aerosol deposition in the lungs of healthy adults following oral and nasal inhalation. Thorax 48:1045–6
El Taoum KK, Jinxiang X, Kim J, et al (2015) In Vitro Evaluation of Aerosols Delivered via the Nasal Route. Respir Care 60:1015–25
Chatmongkolchart S, Schettino GP, Dillman C, et al (2002) In vitro evaluation of aerosol bronchodilator delivery during noninvasive positive pressure ventilation: effect of ventilator settings and nebulizer position. Crit Care Med 30:2515–9
Calvert LD, Jackson JM, White JA, et al (2006) Enhanced delivery of nebulized salbutamol during non-invasive ventilation. J Pharm Pharmacol 58:1553–7
White CC, Crotwell DN, Shen S, et al (2013) Bronchodilator delivery during simulated pediatric noninvasive ventilation. Respir Care 58:1459–66
Abdelrahim ME, Plant P, Chrystyn H (2010) I-vitro characterization of the nebulized dose during non-invasive ventilation. J Pharm Pharmacol 62:966–72
Michotte JB, Jossen E, Roeseler J, et al (2014) In vitro comparison of five nebulizers during noninvasive ventilation: analysis of inhaled and lost doses. J Aerosol Med Pulm Drug Deliv 27:430–40
Branconnier MP, Hess DR (2005) Albuterol delivery during noninvasive ventilation. Respir Care 50:1649–53
Dhand R (2012) Aerosol therapy in patients receiving noninvasive positive pressure ventilation. J Aerosol Med Pulm Drug Deliv 25:63–78
Dai B, Kang J, Sun LF, et al (2014) Influence of exhalation valve and nebulizer position on albuterol delivery during noninvasive positive pressure ventilation. J Aerosol Med Pulm Drug Deliv 27:125–32
Bhashyam AR, Wolf MT, Marcinkowski AL, et al (2008) Aerosol delivery through nasal cannulas: An in vitro study. J Aerosol Med Pulm Drug Deliv 21:181–8
Ari A, Harwood R, Sheard M, et al (2011) In vitro comparison of heliox and oxygen in aerosol delivery using pediatric high flow nasal cannula. Pediatr Pulmonol 46:795–801
Sunbul FS, Fink JB, Harwood R, et al (2015) Comparison of HFNC, bubble CPAP and SiPAP on aerosol delivery in neonates: An in-vitro study. Pediatr Pulmonol 50:1099–106
Perry SA, Kesser KC, Geller DE, et al (2013) Influence of cannula size and flow rate on aerosol drug delivery through the Vapotherm humidified high-flow nasal cannula system. Pediatr Crit Care Med 14:250–6
Fok TF, Monkman S, Dolovich M, et al (1996) Efficiency of aerosol medication delivery from a metered dose inhaler versus jet nebulizer in infants with bronchopulmonary dysplasia. Pediatr Pulmonol 21:301–9
Réminiac F, Vecellio L, Heuzé-Vourc’h N, et al (2015) Aerosol Therapy in Adults Receiving High Flow Nasal Cannula Oxygen Therapy. J Aerosol Med Pulm Drug Deliv [in press]
França EE, Dornelas de Andrade AF, Cabral G, et al (2006) Nebulization associated with bi-level noninvasive ventilation: analysis of pulmonary radioaerosol deposition. Respir Med 100:721–8
Maccari JG, Teixeira C, Savi A, et al (2014) Nebulization during spontaneous breathing, CPAP, and bi-level positive-pressure ventilation: a randomized analysis of pulmonary radioaerosol deposition. Respir Care 59:479–84
Reychler G, Leal T, Roeseler J, et al (2007) Effect of continuous positive airway pressure combined to nebulization on lung deposition measured by urinary excretion of amikacin. Respir Med 101 2051–5
Ehrmann S, Mercier E, Vecellio L, et al (2008) Pharmacokinetics of high-dose nebulized amikacin in mechanically ventilated healthy subjects. Intensive Care Med 34:755–62
Galindo-Filho VC, Ramos ME, Rattes CS, et al (2015) Radioaerosol Pulmonary Deposition Using Mesh and Jet Nebulizers During Noninvasive Ventilation in Healthy Subjects. Respir Care 60:1238–46
Parkes SN, Bersten AD (1997) Aerosol kinetics and bronchodilator efficacy during continuous positive airway pressure delivered by face mask. Thorax 52:171–5
Nava S, Karakurt S, Rampulla C, et al (2001) Salbutamol delivery during non-invasive mechanical ventilation in patients with chronic obstructive pulmonary disease: a randomized, controlled study. Intensive Care Med 27:1627–35
Pollack CV, Fleisch KB, Dowsey K (1995) Treatment of acute bronchospasm with beta-adrenergic agonist aerosols delivered by a nasal bilevel positive airway pressure circuit. Ann Emerg Med 26:552–7
Brandao DC, Lima VM, Galindo Filho V, et al (2009) Reversal of Bronchial Obstruction with Bi-level Positive Airway Pressure and Nebulization in Patients with Acute Asthma. J Asthma 46:356–61
Thille AW, Bertholon JF, Becquemin MH, et al (2011) Aerosol Delivery and Humidification With the Boussignac Continuous Positive Airway Pressure Device. Respir Care 56:1526–32
Galindo-Filho VC, Brandao DC, Ferreira RCS, et al (2013) Noninvasive Ventilation Coupled With Nebulization During Asthma Crisis: A Randomized Controlled Trial. Respir Care 58:241–9
Fauroux B, Itti E, Pigeot J, et al (2000) Optimization of aerosol deposition by pressure support in children with cystic fibrosis: an experimental and clinical study. Am J Respir Crit Care Med 162:2265–71
Iosson N (2006) Nebulizer-associated anisocoria. N Engl J Med 354:e8
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Réminiac, F., Bodet-Contentin, L., Vecellio, L. et al. Aérosolthérapie au cours de l’assistance respiratoire non invasive. Réanimation 25, 11–20 (2016). https://doi.org/10.1007/s13546-015-1158-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13546-015-1158-z