Aerosol Therapy for Ventilator-Dependent Patients: Devices, Issues, Selection & Technique

Aerosol devices have been used to administer inhaled medications since the invention of modern mechanical ventilators. Although many new aerosol devices are available for ventilator-dependent patients, successful aerosol therapy still depends on thorough clinician knowledge of aerosol devices and their proper use. This paper explains the types of aerosol devices available on the market and provides strategies for choosing the right device for optimal treatment of mechanically-ventilated patients

Jet, Ultrasonic, and Mesh Nebulizers: An Evaluation of Nebulizers for Better Clinical Outcomes

For over a century, nebulizers have been commonly used to deliver aerosolized medications in the treatment of patients with pulmonary diseases. They are the aerosol device of choice when patients can not coordinate inhalation and actuation needed for the use of the pressurized metered-dose inhalers (pMDIs) or are not able to provide the necessary inspiratory flow required by the dry powder inhaler (DPI) for effective aerosol drug delivery. Three types of nebulizers exist: (1) jet nebulizers, (2) ultrasonic nebulizers, and (3) mesh nebulizers. The purpose of this paper is to explain the types of nebulizers available on the market and to evaluate their efficiencies in aerosol drug delivery while suggesting strategies for the optimal treatment of patients with pulmonary diseases

Drug delivery interfaces: A way to optimize inhalation therapy in spontaneously breathing children

There are several different types of drug delivery interfaces available on the market. Using the right interface for aerosol drug delivery to children is essential for effective inhalation therapy. However, clinicians usually focus on selecting the right drug-device combination and often overlook the importance of interface selection that lead to suboptimal drug delivery and therapeutic response in neonates and pediatrics. Therefore, it is necessary to critically assess each interface and understand its advantage and disadvantages in aerosol drug delivery to this patient population. The purpose of this paper is to provide a critical assessment of drug delivery interfaces used for the treatment of children with pulmonary diseases by emphasizing advantages and problems associated with their use during inhalation therapy

Orthognathic Surgery in Cleft Lip and Palate Patients

Cleft lip and palate patients often exhibit severe dentofacial deformities that necessitate orthognathic surgery. Orthognathic surgery in these patients generally includes not only maxillary advancement, but also sagittal, horizontal, and vertical movement of both jaws. Surgical planning and execution presents many difficulties, caused by the presence of extensive scar tissues from previous surgeries, tissue deficiencies, the difficulty of aligning multiple segments of bone and soft tissues. Other challenges in cleft patients are complications related to post-surgical airway, speech, velopharyngeal insufficiency, nerve damage, and infections. This review is focused on orthognathic surgery in cleft lip and palate patients, management, techniques, success, and complications

Use of Aerosol Drug Therapy in Pulmonary Rehabilitation

Clinical applications of pulmonary rehabilitation are patientfocused and consist of individualized therapies such as aerosol drug therapy, airway clearance, chest physical therapy, exercise, and patient education. Devices that are used in aerosol drug delivery are divided into the following 3 categories: (1) small volume nebulizers, (2) metered-dose inhalers, and (3) dry powder inhalers. Although these devices are commonly used for the treatment of patients with pulmonary diseases, there are a limited number of objective studies on the physiologic and clinical effects of aerosol drug therapy on pulmonary rehabilitation. The purpose of this review paper is to explain all the devices used for aerosol drug delivery and how to use each device in the concept of pulmonary rehabilitation

From Admission to Graduation: The Impact of Gender on Student Academic Success in Respiratory Therapy Education

Despite research in other allied health professions and medicine, the influence of gender on student performance in respiratory therapy (RT) academic programs and on the National Board for Respiratory Care (NBRC) examinations is unknown. Therefore, the purpose of this study was to identify the impact of gender on student academic performance from admission to graduation and to determine whether gender differences affected student success on the NBRC examinations. This study consisted of a retrospective analysis of 91 female and 22 male graduates at a southeastern U.S. university between 2003 and 2007. The variables of academic success included the students\u27 entering GPA, exit GPA, and first-attempt performance on the Certified Respiratory Therapy (CRT) examination and on the Written Registry for Respiratory Therapy (WRRT) examination. Independent sample t-test and paired sample t-test analyses at a level of significance of α = 0.05 were utilized. No significant gender differences were observed in the measures of students\u27 entering GPA, exit GPA, or performance on scaled CRT and WRRT examinations (p \u3e 0.05). When we compared entering GPAs and exit GPAs, a statistically significant difference was found (p \u3c 0.05). Both male and female RT students had significantly higher exit GPAs than entering GPAs. The results of the study showed that gender plays no role in the academic success of RT students. When looking at the changes on academic success, we conclude that RT students work hard, as the graduation scores are higher than admission scores

Secondhand aerosol exposure during mechanical ventilation with and without expiratory filters: An in-vitro study

Background: Concerns have been expressed about risk of exposure to exhaled aerosols to ICU personnel. AIM: To quantify amount of aerosol collected at the exhaust outlet of mechanical ventilators operated with and without filters in the expiratory limb. Methods: Two categories of ventilators were tested: (1) Ventilators without Proprietary Filters: Servo-i (Maquet) and Galileo (Hamilton) and (2) Ventilator with proprietary filters: PB 840 (Covidien). Each ventilator was attached to a simple test lung and operated with VT 500 ml, RR 20 bpm, PIF 50 L/min, PEEP 5 cmH2O. Four separate doses of albuterol (2.5 mg/3mL) were administered via jet nebuliser (eValueMed, Tri-anim) placed at the “Y”. In Experiment A, a filter (Respirgard 303) was placed at the exhaust port. In Experiment B, two filters were attached to the ventilators without proprietary filters: (1) at the end of expiratory limb and (2) at the exhaust outlet. Drug was eluted from filters and measured using spectrophotometry. Results: Drug deposited at the exhaust port without expiratory filtering was \u3e160 fold higher than with expiratory filtering. The collecting filter used in this study was less efficient than the proprietary filter designed for use with the ventilator. Regardless of type of filter used, placement of filter in the expiratory limb reduced secondhand aerosol exposure significantly. Conclusion: Risk of secondhand exposure to exhaled aerosol can account for \u3e45% of nominal dose as well as droplet nuclei produced by patients. Using expiratory filters decreases risk of exposure to aerosol released to the atmosphere during mechanical ventilation

Unusual causes of peritonitis in a peritoneal dialysis patient: Alcaligenes faecalis and Pantoea agglomerans

An 87 -year-old female who was undergoing peritoneal dialysis presented with peritonitis caused by Alcaligenes faecalis and Pantoea agglomerans in consecutive years. With the following report we discuss the importance of these unusual microorganisms in peritoneal dialysis patients

Performance Comparisons of Jet and Mesh Nebulizers Using Different Interfaces in Simulated Spontaneously Breathing Adults and Children

Background: Different types of nebulizers and interfaces are used for the treatment of adults and children with pulmonary diseases. The purpose of this study was to determine the efficiency of a mesh nebulizer (MN) with a proprietary adapter and a jet nebulizer (JN) under different configurations in adult and pediatric models of spontaneous breathing. We hypothesize that delivery efficiency of JN and MN will differ depending on the interface used during aerosol therapy in simulated spontaneously breathing adult and pediatric models. While we expect that aerosol delivery with JN will be less efficient than MN, we also hypothesize that lung deposition obtained with the adult lung model will be more than that with the pediatric lung model in all conditions tested in this study. Methods: A lung model using a teaching manikin connected to a sinusoidal pump via a collecting filter at the level of the bronchi simulating a spontaneously breathing adult (Vt 500 mL, RR 15 bpm, I:E ratio 1:2) or pediatric patient (Vt 150 mL, RR 25 bpm, I:E ratio 1:2). Albuterol sulfate (2.5 mg/3 mL) was aerosolized with JN (Mistymax 10, Airlife) or MN (Aerogen Solo®, Aerogen) with the Adapter (Aerogen Solo® Adapter, Aerogen Ltd, Galway, Ireland) using mouthpiece, aerosol mask, and valved-mask in adults and the dragon mask, aerosol mask, and valved-mask in pediatrics (n=3). The Adapter, specifically designed for MN, was attached to all the interfaces used in this study with supplemental oxygen of 2 lpm, and in addition, the MP was tested with no additional flow in the adult model. The JN was driven with 10 lpm based on the manufacturer\u27s label. Drug was eluted from the filter and analyzed via spectrophotometry. Descriptive statistics, dependent t-test and one-way analysis of variance were used for data analysis. Significant level was set at 0.05. Results: In adults, delivery efficiency of JN with the valved mask was significantly greater than that with the aerosol mask (p=0.01). Aerosol delivery of JN with the mouthpiece was not statistically significant from the valved mask (p=0.123) and the aerosol mask (p=0.193). Drug delivery with MN with mouthpiece (15.42±1.4%) and valved-mask (15.15±1.1%) was greater than the open aerosol mask (7.54±0.39%; p=0.0001) in the adult lung model. With no flow mouthpiece delivery increased\u3e2 fold (34.9±3.1%; p=.0001) compared to use of 2 lpm of flow. Using the JN with the pediatric model deposition with valved-mask (5.3±0.8%), dragon mask (4.7±0.9%), and aerosol mask (4.1±0.3%) were similar (p\u3e0.05); while drug delivery with MN via valved-mask (11.1±0.7%) was greater than the dragon mask (6.44±0.3%; p=0.002) and aerosol mask (4.6±0.4%; p=0.002), and the dragon mask was more efficient than the open aerosol mask (p=0.009) Conclusion: The type of nebulizer and interface used for aerosol therapy affects delivery efficiency in these simulated spontaneously breathing adult and pediatric models. Drug delivery was greatest with the valved-mouthpiece and mask with JN and MN, while the standard aerosol mask was least efficient in these simulated spontaneously breathing adult and pediatric lung models. Delivery efficiency of JN was less than MN in all conditions tested in this study except in the aerosol mask. Lung deposition obtained with the adult lung model was more than that with the pediatric lung model