Aerosol Therapy During Noninvasive Ventilation or High-Flow Nasal Cannula

Noninvasive ventilation (NIV) and high-flow nasal cannula (HFNC) are increasingly used for patients with acute respiratory failure. Some patients receiving these therapies might also benefit from inhaled drug delivery. Thus, it is attractive to combine aerosol therapy with NIV or HFNC. The purpose of this paper is to review the available evidence related to the use of inhaled aerosols with NIV or HFNC. Available evidence supports the delivery of aerosols during NIV. Inhaled bronchodilator response might be improved with the use of NIV in acute asthma, but the evidence is not sufficiently mature to recommend this as standard therapy. Evidence does support aerosol delivery without discontinuation of NIV. Clinical studies on aerosol delivery during HFNC are needed, and based on the available in vitro evidence, it is not possible to make a recommendation for or against aerosol delivery during HFNC.