High flow oxygen and nebulizer treatments

By Timothy Howald posted 03-07-2018 16:36

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Does anyone know of any standards regarding giving nebulizer treatments while a patient are on high flow oxygen. I would think someone at 60 l/m would not get any medication with a mouth piece nebulizer. I also have staff putting the treatment inline which you would think the medication gets diluted to nothing. Any ideas, literature or is there any gold standards? Thanks

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Gregory Rittenhouse

10-24-2018 08:33

We use a vibrating mesh neb and put it on the patient side of the heater. We haven't encountered any issues using this method.

Christopher Whelchel

03-23-2018 04:46

Hi Timothy,

I've come across this in practice before and although I never found data to back it up, I think our knowledge should be used for administration.

What I have done in the past is reduce the flow during high flow and then administered either inline or via mouthpiece neb. I used my best judgement (as you have) that with such a high flow, the delivered particles would therapeutically be useless. The medication droplets must have time to settle in the appropriate parts of the airway and therefore, the flow should be reduced.

If the patient has an increased WOB, this can be challenging. If the high flow is more for oxygenation, that can be addressed by a temporary increase in FiO2 with a reduction of flow (yes, even for severe COPD).

Does that make sense? In a nutshell, reduce flow... administer inline or mouthpiece (best judgement), increase FiO2.

If you are using a jet nebulizer then the additional flow added via MP could help with overall delivered flow to the patient.

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