www.bjorl.org
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
ORIGINAL
ARTICLE
New
Ringer’s
lactate
gel
formulation
on
nasal
comfort
and
humidification
夽
Maura
Catafesta
das
Neves
a,∗,
Fabrizio
Ricci
Romano
a,b,
Samuel
Guerra
Filho
c aUniversidadedeSãoPaulo(USP),HospitalUniversitário(HU),SãoPaulo,SP,BrazilbHospitalInfantilSabará,SãoPaulo,SP,Brazil
cAllergisaPesquisaDermato-CosméticaLtda,Campinas,SP,Brazil
Received29March2018;accepted4July2018 Availableonline8August2018
KEYWORDS Dryness; Nasalhydration; Nasalwash; Rhinitis; Nasalgel; Ringerlactate Abstract
Introduction:Theuseofsalineirrigationfornasalwashesisawellestablishedprocedurein thetreatmentofsinonasalinflammationandinfection.Inadditiontosalinesolutions,Ringer’s lactateisalsoanefficientoptionfornasalwashesandhumidification.
Objective:Toassessthecomfort,humidificationandtoleranceregardingstingingsensation, providedbysodiumchloridenasalgelattheconcentrationsof4.5mg/gand6.0mg/gthrough questionnairesansweredbythepatients.
Methods:Atotalof60patients,56females,agedbetween22and66yearsold(meanageof47) and4males,agedbetween36and66years(meanageof49),wereincludedinthestudyfora periodof17days(±2days)treatment.Thepatientsweremonitoredbyageneralpractitioner throughoutthestudyperiod.Theywereinstructedtoapplyeachproductinbothnostrilstwice adayduringa7-day period(±2days). Thepatients wereevaluatedprior totheuseofthe firstproductatvisit0(V0),after7daysoftreatment(±2days)atvisit1(V1),after3daysof productdiscontinuationatvisit2(V2)andafter7days(±2days)oftreatmentwiththesecond product,invisit3(V3).
Results:Asignificantdifference(5%significance)wasobservedregardingcomfortandstinging sensationbetweenthetwodifferentconcentrations;comfortwashigherandstingingwaslower withthe6.0mg/gconcentrationgel.Nodifferenceinhumidificationwasobservedbetweenthe twotreatments.
Conclusion:Ringer’slactateattheconcentrationof6.0mg/gwassuperiortothatat4.5mg/g forparameterscomfortandstingingsensation.Nostatisticaldifferencewasobservedbetween thetwoproductsregardingnasalhumidification.
© 2018 Associac¸˜ao Brasileira de Otorrinolaringologia e Cirurgia C´ervico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).
夽 Pleasecitethisarticleas:NevesMC,RomanoFR,GuerraFilhoS.NewRinger’slactategelformulationonnasalcomfortandhumidification. BrazJOtorhinolaryngol.2019;85:746---52.
∗Correspondingauthor.
E-mail:mauraneves@hotmail.com(M.C.Neves).
PeerReviewundertheresponsibilityofAssociac¸ãoBrasileiradeOtorrinolaringologiaeCirurgiaCérvico-Facial.
https://doi.org/10.1016/j.bjorl.2018.07.004
1808-8694/©2018Associac¸˜aoBrasileiradeOtorrinolaringologiaeCirurgiaC´ervico-Facial.PublishedbyElsevierEditoraLtda.Thisisanopen accessarticleundertheCCBYlicense(http://creativecommons.org/licenses/by/4.0/).
PALAVRAS-CHAVE Ressecamento; Hidratac¸ãonasal; Lavagemnasal; Rinite;
Gelnasal; Ringerlactato
Novaformulac¸ãodeRingerlactatogelnoconfortoeumidificac¸ãonasal
Resumo
Introduc¸ão: Ousodesoluc¸õessalinasparalavagemnasalestáconsagradonotratamentode quadrosinflamatórioseinfecciososnasossinusais.Alémdassoluc¸õessalinas,oringerlactatoé umaimportanteopc¸ãotantoparalavagemquantoparaahidratac¸ãonasal.
Objetivo: Avaliaratolerabilidade(ardênciaeconforto)eumidificac¸ãodoprodutogelnasal cloretodesódio 4,5mg/gemrelac¸ãoao ringerlactato6,0mg/g,pormeiodequestionários respondidospelospacientes.
Método: Foramincluídos 60 pacientes, 56 mulheres (22-66anos; média: 47 anos) e quatro homens(36-66anos;média:49anos)foramincluídosnoestudode17dias(±2dias)de trata-mento. Ospacientesforamsupervisionadosporum clínico geraldurantetodooperíododo estudo.Ospacientesusaramosprodutos comuma borrifadaemcadanarinaduasvezes ao dia, durantesetedias(±2dias).Asformulac¸õesforamavaliadas antesdousodoprimeiro produtonavisita0(V0),apóssetedias(±2dias)detratamentonavisita1(V1),apóstrêsdias deinterrupc¸ãodoprimeirotratamentonavisita2(V2)eapóssetedias(±2dias)deusodo segundoprodutonavisita3(V3).
Resultados: Foiobservadadiferenc¸asignificanteparaoconfortodasviasnasais,(significância de5%),nacomparac¸ãoentreostratamentosnosatributosdeconfortoeardência.Oconforto dasviasnasaisfoisuperior eaardênciainferiorparaogelnasalringerlactato6,0mg/gem comparac¸ãoaogelcloretodesódio4,5mg/g.Nãofoiobservadadiferenc¸asignificanteparaa umidificac¸ãoentreostratamentos.
Conclusão:Ogelringerlactato6,0mg/gfoisuperioraoprodutogelcloretodesódio4,5mg/g nos quesitosconforto eardência.Nãofoi observadadiferenc¸aestatisticamentesignificante entreostratamentosemrelac¸ãoàumidificac¸ãodasviasnasais.
© 2018 Associac¸˜ao Brasileira de Otorrinolaringologia e Cirurgia C´ervico-Facial. Publicado por Elsevier Editora Ltda. Este ´e um artigo Open Access sob uma licenc¸a CC BY (http:// creativecommons.org/licenses/by/4.0/).
Introduction
Inflammatoryconditionsofthenose andparanasalsinuses arethemostprevalentgroupofdiseasesinthegeneral popu-lation.Allergicandnon-allergicrhinitis,aswellasacuteand chronicrhinosinusitis,resultinamarkeddecreaseinquality oflifeandgeneratesignificantlossesinlaborproductivity, leisureandsocialactivitiesingeneral.1
Nasal topical medications are extremely important in the treatment of inflammatory and infectious nasal and paranasalsinusdiseases,allowingactivesubstancestoreach thetargetedsiteinordertoexerttheirclinicallocalaction, minimizingthesystemiceffects.1
Themajorityofacuterespiratoryinfectionsareofviral etiology,oftenpresenting a self-limitingcourse.However, the associated symptoms (rhinorrhea, nasal obstruction, cough,painandfever)arefrequentlyareasonofhigh med-icationconsumption.2
Theuseofsalinesolutionfornasalhygienehasbeen rec-ommendedbymanyexpertsinrhinology,anditseffectmay begreaterthanjustthatofanadjuvanttreatment.1
Nasal lavage with isotonic saline (0.9% sodium chlo-ride) is recommended in respiratory infections aiming to help the mechanical removal of secretions and microor-ganisms in addition toincreasing nasal permeability. It is an easy-to-perform procedure with no relevant adverse clinical effects, well tolerated, and beneficial to the organism.2
Sodiumchloridenasalsprays,nasalgelsandRinger’s lac-tatenasalgelsarerecommendedtohelpthefluidificationof secretions.Theyactbydecreasingthemucusviscosity, pro-motingitsfluidizationand facilitatingitselimination,and areusuallyindicatedinanyconditionrelatedtodrynessof thenasalmucosa,suchaslowairhumidity,exposuretoair conditioningandpollution.
Currently, thenasal gel 4.5mg/g, that is highly effec-tivefornasalhydration,isalreadyavailableonthemarket.3
However,itsformulationisbasedonaglycoliccomponent (propyleneglycol)thatproducesanasalstingingsensation immediatelyafteritsapplication.3Aimingtoincreasenasal
comfortmaintainingthequalityofthehydration,anewgel formulationbased onRinger’slactate solutionwas devel-oped,whichresultedinaconcentrationof6.0mg/g,without theglycoliccomponent.4
Thisstudyaimstocomparethetolerability(stinging sen-sation and comfort) and the efficacy of nasal hydration betweensodiumchloridenasalgelat4.5mg/gandRinger’s lactatenasalgelat6.0mg/g.
Methods
Asingle-blind,comparative,monadic,sequential, random-ized clinical study with a wash-out period of 3 days was carriedoutinNovemberandDecember2014.
The enrolledsample consisted of patients with recom-mendationofnasalgelapplication,whomettheinclusion
Table 1 Standardization of sample labels delivered to patients. Typeof product Product code Product lot Product validity Nasalgel 43329-01 LP247/14A 09/2016 Nasalgel 43329-02 14/0042 09/2016
criteria and none of the exclusion criteria. The selected patientsattendedthevisitsfortheevaluationsrequiredby thetrialandsignedthefreeinformedconsentform,inorder tobeincludedinthestudy.
The inclusion criteria comprised: participants of both genders;age>18years;adherencetothestudyprocedures andrequirements;attendancetotheclinicontheday(s)and timepreviouslydeterminedfortheevaluations,andwriting abilitytoprovidetheconsentformtotheirparticipation.
Exclusioncriteriaincluded:concomitantuseofanyother nasal medication; pregnancy or breastfeeding; diabetes; immunedeficiencydiseases;useofsystemiccorticosteroids orimmunosuppressantsinaperiodnotlargerthan2weeks beforethebeginningofthestudy;previousreactiontothe tested productcategory; other diseases andlicit or illicit medications that might directly could interfere with the studyorendangerthevolunteer’shealthandanyother pre-viouslyunmentionedconditionswhich,intheopinionofthe investigator,couldimpairthestudyevaluation.
The sample size wasdetermined based on the ANVISA guidetocosmeticproductstudies,5whichrequiresa
mini-mumnumberof30responsesforsafetystudies.Therefore, asampleof60patientswasestablished.Patientrecruitment wascarriedoutbyAllergisa, acompanywitha computer-izedandupdatedregistrysystemof individualsinterested inresearchesparticipation.
ThesponsorcompanyLibbsFarmacêuticaLTDAprovided the nasal gel samples to the researcher,3,4 which were
evaluatedinstandardized packagesidentifiedwithalabel indicatingonlythetypeofproduct,productcode,validity andsamplelotasshowninTable1.Thenameofthe prod-uct wasnot identified onthe sample labels of the study. Code43329-1correspondedtoRinger’slactatenasalgel,at 6.0mg/g,4whereascode43329-02correspondedtosodium
chloridenasalgel,at4.5mg/g.3
Studydesign
Patientswereassessedbyageneralpractitionerforinclusion andexclusioncriteriaandfor theirclinical status(history of diseases, allergies, blood pressure and general physi-calexamination)at visit0(V0).Approvedfemalepatients underwentalsotoaurinarypregnancytestonV0.
Aftergivingtheirinformedconsentandbeingincluded, thepatientsreceivedoneoftheproductstobeappliedto thenosefor7±2days(onesprayineachnostrilevery12h). Productprescriptionwasrandomized,sothatthepatients didnotknowwhichproducttheywereusing.
After7±2daysthepatientswereevaluatedatvisit1(V1) formonitoringtheonsetofanyadverseevents,answeringa questionnairetoevaluatetheproduct.
Table2 Scheduleofprocedure.
Stage V0 V1 V2 V3
Signatureoftermofinformedconsent X
Clinicalevaluation X X X X
Pregnancytest X X
Evaluationofefficacyandtolerability X X
Productdelivery X X
Productreturn X X
Aftera3-day intervalwithoutusing anyproduct(wash out), thepatients returnedfor visit 2(V2) toreceive the second producttobeusedfor7±2days.After7±2days thepatientsreturnedonvisit3(V3)forthefinalassessment (clinical examination and newpregnancy test, for female patients).Table2outlinesthevisitsandfollow-up.
Forthe analysisof the acceptabilityresults, the study considered patients with a minimum adherence of 80% regarding the frequency of use. As the prescription con-sistedoftwiceapplicationsadayfor7days,14applications were expected as the final result. Considering the mini-mum adherenceof 80% regarding the product application frequency,eachparticipantshouldhaveappliedatleast11 timestohavetheirevaluationsvalidandaccountedforthe finalstudyresults.
The efficacy (humidification) and tolerability (stinging sensation andcomfort)evaluation wasperformed through questionnaires answered by the patients. A visual analog scale(VAS)wasusedforeachitemasshowninFigs.1and2. TheinvestigatorshowedtheVASscaletoeachpatientand askedthemtoindicatethepointthatbestrepresentedeach assesseditem.Theinvestigatorverifiedthepointindicated bythepatientinthefigure,whichrangedfrom0(zero)to 10(ten)centimetersandnotedthecorrespondingvalue.In thisscale,thevalueof0(zero)representedthelowest effi-cacyperceivedatthetreatmentandthevalueof10(ten) representedthegreatestefficacy.
Allparticipantswhodidnotmeettheinclusion/exclusion criteria prior to the beginning of the study or that did not agreeparticipating beforeor after theinformed con-sentformsignaturewereconsideredas‘‘selectionfailure’’. Theseparticipantswerereplaced,andtheirdatawerenot considered in the finalreport. Therewasno replacement for thosewhowithdrewafterreceivingtheproductunder investigation.
Thisstudywascarriedoutaccordingtotheprinciplesof theHelsinkiDeclarationofOctober2008,andtheapplicable regulatoryrequestsincludingCNSResolutionNo.466/2012,6
andtheprinciplesofGoodClinicalPractices(Documentof theAmericasandICHE6:GoodClinicalPractice).7Thestudy
wasapprovedbytheinstitutionalresearchethicscommittee (CAAE:37042514.8.0000.5599).
Results
Atotalof60patientswhometalltheinclusionand exclu-sioncriteriawereenrolled,56werefemales,agedbetween 22and66years(mean:47years)andfourweremales,aged between36and66years(mean:49years).Ina complemen-tary study, a primary skin irritation potential of products
0 1 2 3 4 5 6 7 8 9 10
MILD MODERATE SEVERE
VISUAL ANALOGUE SCALE
Figure1 Visualanalogscale---VAS(comfortandstinging).
0 1 2 3 4 5 6 7 8 9 10
For evaluation, the Visual Analog Scale will be used, according to the example below:
MILD MODERATE SEVERE
VISUAL ANALOGUE SCALE
Figure2 Visualanalogscale---VAS(humidification).
Table3 Mean,standarddeviationandresultofthecomparisonbetweentreatments.
Characteristic Ringer’slactatenasalgel6.0mg/g Sodiumchloridenasalgel4.5mg/g pvalue
Mean SD Mean SD
Comfort 8.6 1.7 7.7 2.1 0.003b
Stinging 0.2 1.0 1.5 2.7 <0.001c
Humidification 8.9 1.3 8.6 1.4 0.136
aSignificantatthe5%level(Wilcoxontest). b Significantatthe1%level.
c Significantatthe0.1%level.
(patchtest)wasevaluated.Inthisstudy,noneofthe parti-cipantsshowedclinicalsignsofskinirritationrelatedtothe productandthelatterdidnotinduceprimaryskinirritation processinthestudygroup.
Theresultsobtainedforeachassessedcharacteristicare showninTable3.
Asignificantdifferencewasobserved,withasignificance levelof5%,whencomparingthetreatmentsregardingthe characteristicsofcomfortandstingingsensation.The com-fortofnasalapplicationwassuperiorwithRinger’slactate nasalgel,at6.0mg/g4comparedtosodiumchloridenasal
gel,at4.5mg/g.3Thestingingsensationwaslowerforthe
treatment with Ringer’s lactate nasal gel, at 6.0mg/g,4
comparedwiththenasalgel,at4.5mg/g.3Nosignificant
dif-ferencewasobservedregardingnasalhumidification when comparingbothtreatments.
Fig.3 comparesthe dataobtainedregarding the sting-ing sensation for each tested product concentrations, on VAS scale. The stingingsensation was reportedas moder-atetosevereby15patientswhotestedthesodiumchloride nasalgel,4.5mg/g3 andmoderateforonly2patientswho
testedRinger’slactatenasalgel,at6.0mg/g.4Therewere
no reports of intense stinging sensation among patients thatusedRinger’slactategel atthe concentrationof6.0 mg/g.4
Thestingingsensationwasreportedasmildby58patients whotested for the concentration of 6.0mg/g4 andby 45
patientsthattestedfortheconcentrationof4.5mg/g3(Fig. 3).The stingingsensation wasreportedasZERO(included as mild in the VAS scale) by 57 patients (95%) tested for ringer’slactategel ata concentrationof6.0mg/g4 vs. 41
0 20 40 60 80 100
Intense Moderate Mild
Nasal gel 6.0mg/g 0 3.3 96.7
Nasal gel 4.5mg/g 8.3 16.7 75
%
STINGING
Figure 3 Stinging with nasal gel 6.0mg/g4×nasal gel
4.5mg/g.3
patients(68.3%)whotestedthesodiumchloridenasalgelat aconcentrationof4.5mg/g3(Fig.4).
Regardingthecomfort,Ringer’slactategelat6.0mg/g4
providedintensecomfortfor47patients(78.3%)and mod-erate for 13 patients, (21.7%) while the concentration of 4.5mg/g3 provided intensecomfortfor 36 (60%)patients,
moderate for 22 (36.7%) and mild for 2 patients (3.3%) (Fig.5).
Regardinghumidification,theconcentrationof6.0mg/g4
ofRinger’slactategel providedintensehumidification for 48 (80%) patients and moderate for 13 (20%), while the concentrationof4.5mg/g3ofthesodiumchloridenasalgel
providedintensehumidificationfor47(78.4%)andmoderate for13patients(21.6%),asshowninFig.6.
0 1 2 Nasal gel 6.0mg/g 95 1.7 0 Nasal gel 4.5mg/g 68.3 5 1.7 0 20 40 60 80 100 % MILD STINGING
Figure4 DivisionofmildstingingreportsforRinger’slactate nasalgel6.0mg/g4×sodiumchloridenasalgel4.5mg/g.3
0 10 20 30 40 50
Intense Moderate Mild
Nasal gel 6.0mg/ml 47 13 0
Nasal gel 4.5 mg/ml 36 22 2
N
COMFORT
Figure 5 Comfort with nasal gel 6.0mg/g4×nasal gel
4.5mg/g.3 0 10 20 30 40 50 Intense o
Moderate Mild Zero
Nasal gel 6.0 mg/g 48 12 0 0
Nasal gel 4.5mg/g 47 13 0 0
N
HUMIDIFICATION
Figure 6 Humidification with Ringer’s lactate nasal Gel 6.0mg/g4×sodiumchloridenasalgel4.5mg/g.3
Fig.7comparestheresultsobtainedforeach character-isticevaluatedforeachnasalgelconcentration.
Discussion
Theuseofisotonicsalinesolutionsfornasalcleaningiswell disseminated and clinically established for more than 70 yearsasa practical, effective andwell tolerated method ofpromotingwell-beingandnasalphysiologymaintenance.8
Thesesolutionsarerecommendedascomplementary ther-apy in cases of acute and chronic rhinosinusitis, rhinitis, post-nasal drip, septum perforation and postoperative care.9,10
COMFORT
% PATIENTS WITH INCREASE % PATIENTS WITH NO DIFFERENCE % PATIENTS WITH DECREASE
STINGING HUMIDIFICATION 20 30 50 3.3 31.7 65 38% 20% 42%
Figure7 Percentageofparticipantswithincrease,no differ-enceandwithreductionofcharacteristicsduringthetreatment withRinger’slactatenasalgel6.0mg/g4×nasalgel4.5mg/g.3
Theiractionmechanisminvolvesthemechanicalremoval of mucus, crusts and nasopharyngeal secretion and alter-ation of the viscoelastic characteristics of the mucus (hydrating it through osmotic gradient and altering the bonds between glycoproteins), which facilitates the mucociliaryclearance.11
Thereisnoclearevidenceintheliteratureofwhichtype ofsalinesolutionisthemostappropriateforthisfunction. However,thestudyofBoek8showedthatnasalRinger’s
lac-tateisotonicsolutionismoreappropriatethanothernasal salinesolutions.
Accordingtotheliterature,every100mLofringer’s lac-tatesolutioncontains600mgofsodiumchloride,310mgof sodiumlactate,30mgof potassium chlorideand 20mg of calcium chloride dihydrate.12---14 This formulationprovides
itsmetabolizationintobicarbonate.Moreover,ringer’s lac-tatesolutionhaspotassiumandcalciumatconcentrations thataresimilartotheionizedconcentrationsfoundin nor-mal blood plasma. To maintain electrical neutrality, the solutionhaslowersodiumlevelthanthatfoundinisotonic salinesolutionorplasma.Thecombinationofallsaltsresults inanosmolaritysimilartheblood,whichmakesthissolution isotonic,withameanpHof6.75(6.0---7.5).12---14
Ringer’slactatenasalgelhasaconcentrationof6mg/g due to the predominant presence of sodium chloride in its composition in solid form (expressed in mg/g) and becomes isotonic with the presence of other ions in its formulation.
This evidencewasconfirmedbyother investigators15---18
whencomparingaringer’slactatesolutionwitha0.9%saline solution,demonstratinga statisticallysignificant improve-ment in mucociliary clearance with the ringer’s lactate solutioncomparedtoothersalinesolutions.
Ringer’slactatesolution12---14showsevidenceofbeingan
excellentnasalhumectant,possiblybecauseitcausesless irritatingeffectsontherespiratorymucosa,evenwhen com-paredto the‘‘physiological’’ 0.9% NaClsaline solutionin experimental19andclinicalstudies.17,20,21Asalimitationof
the present study, we should mention the enrollment of femaleparticipantsinthestudysamplesincethemenstrual cycleperiodwasnotevaluated.
Azzam16 emphasizes that although the isotonic saline
solutionisrecommendedforrepeateduseseveraltimes a dayandthatisveryimportantforthemechanicalremoval of crusts and secretions and nasal lavage, its hydrating power is verylimited andtransitory.The current concept of nasal humidification, according to Azzam,16 should be
directedtothepharmaceuticalformof‘‘gel’’,whichallows alongerperiodofproductadhesiontothenasalmucosa,22
andhavebeenconsideredsafeandeffectiveinseveral clin-icalstudies.18,23,24
Thetestedproductscompriseawidelymarketed formu-lation(sodium chloridenasal spray, at a concentrationof 4.5mg/g3andanewformulation(Ringer’slactatenasalgel,
ataconcentrationof6.0mg/g).4
Twoimportantmodificationsintheformulation differen-tiate thenasal gelat 4.5mg/g3 fromthe Ringer’slactate
nasal gel at 6.0mg/g.4 First, the presence of more ions
in the Ringer’s lactate solution is the base of the nasal gelat aconcentrationof 6.0mg/g,4 which confersunique
propertiestothisformula.Furthermore,propyleneglycol, whichprovidesthegelconsistencyforthenasalgelformula at4.5mg/g3 wasremoved fromthenasalgelat 6.0mg/g,
andreplacedbyhydroxyethylcellulose(HEC).4HEC25,26isa
semi-syntheticviscoelasticpolymerderivedfromthe water-solublecellulose polysaccharide withaosmotic potential, currently used in ophthalmologic products,26 in oral
cap-sulesandtablets,25 tostabilizeliposolubledrug solutions,
asaplasmaexpander,asahemostaticagentandassurface hydratingagent.23,25
Inclinicalstudies,theuseofHECasavehiclefornasal solutionshasbeenreportedasverysafe.Severalpublished studieshaveshownthatnasalsolutionswiththiscomponent donothavesignificantsideeffects.15Thissuitabilityhas
pro-motedgreater comfort, minimizing the stingingsensation thatis frequently experiencedwiththe previous formula-tion.
The results showed greater tolerability when using Ringer’slactategelat6.0mg/g4whencomparedtothe
cur-rently marketed nasal gel at 4.5mg/g3 providing greater
comfortand lower incidence of stinging sensation, which were statistically significant. Approximately 95% of the patientsreportednostingingsensation whenapplyingthe nasalgelataconcentrationof6.0mg/g4whencomparedto
68%ofthepatientsusingthenasalgelataconcentrationof 4.5mg/g.3Moreover,thepatientsshowedthesame
percep-tionofnasalhydrationwithbothproductsusedinthisstudy, whichindicatessimilarefficacybetweentheformulations.
The currently marketedformulationhas multiple clini-caluses,includingpostoperativenasalsurgery,15inaddition
toseveralclinicalconditionssuchasrhinitis,sinusitis,use of continuous positive air pressure (CPAP), among other mucosaldrynessconditions.3,16,24 Anew formulation
with-outtheglycoliccomponent(responsibleforsomestinging) andbasedonringer’slactatesolutionwillprovidegreater comfortandhydrationmanyclinicalconditions.4,16,17,20
Conclusion
Ringer’slactategelisanalternativefornasalhumidification byconferringnasalcomfortwithhighleveloftoleranceand minimalstingingsensation.Ringer’slactategelformulation at6.0mg/g4 wassignificantlysuperior tothat at4.5mg/g
sodiumchloride nasal gel formulation3 regarding comfort
andstinging, while the humidification sensation was high forbothconcentrations.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
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