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Respir Care. 2018 Jul;63(7):886-893. doi: 10.4187/respcare.05880. Epub 2018 May 29.

Incorporating a Nebulizer System Into High-Flow Nasal Cannula Improves Comfort in Infants With Bronchiolitis.

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Pediatric Intensive Care Unit, Centro Hospitalario Burgo, Burgos, Spain.
Pediatric Intensive Care Unit, Centro Hospitalario Burgo, Burgos, Spain.
Department of Pediatrics, Centro Hospitalario Burgos, Burgos, Spain.
Department of Pediatrics, Hospital Virgen de la Concha, Zamora, Spain.



High-flow nasal cannula (HFNC) is increasingly used to provide respiratory support in infants with bronchiolitis. The delivery of aerosol therapy through a jet nebulizer is widely indicated despite its controversial efficacy and poor tolerability.


This randomized cross-over study aimed to evaluate the comfort and satisfaction of the delivery of aerosol therapy using a nebulization system integrated into HFNC compared with the standard practice of using a jet nebulizer with a face mask. The COMFORT-Behavior (COMFORT-B) scale, a visual analog scale, and a numeric rating scale were used by health professionals and caregivers to assess subjects' levels of comfort and satisfaction.


A total of 113 nebulizations (64 via nebulizer with HFNC; 49 via jet nebulizer) were delivered to the 6 subjects included in the study. Use of the nebulizer with HFNC showed increased comfort and satisfaction during nebulization compared to use of the jet nebulizer, as measured by the COMFORT-B scale, the visual analog scale, and the numeric rating scale, with the following median (interquartile range) scores: 10.7 (7-16) versus 14.5 (10-20) (P = .006), 8.5 (6-10) versus 7 (4-9) (P = .02), and 3.84 (3.61-4.07) versus 1.83 (1.58-2.08) (P < .001), respectively. Correlation between the COMFORT-B scale and the visual analog scale using Spearman's rho was -0.757 (P < .001). The intraclass correlation coefficient for the COMFORT-B scale, visual analog scale, and numeric rating scale, as measured by 2 different nurses, was between 0.75 and 0.87.


The use of a nebulizer incorporated into HFNC therapy results in an increased level of comfort and satisfaction compared to the use of a conventional jet nebulizer in subjects with bronchiolitis who required HFNC therapy. Further studies are needed to determine whether aerosol therapy delivered through HFNC improves the clinical course of this pathology.


bronchiolitis; comfort; high-flow oxygen therapy; jet nebulizer; nebulization; satisfaction


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