Resp Care
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Comparative Study
In vitro comparison of the circulaire and AeroTee to a traditional nebulizer T-piece with corrugated tubing.
Nebulizers are a popular means of delivering aerosolized medication, primarily albuterol, to the bronchial airways of patients, and there has been extensive research done on numerous nebulizers used with nebulizer T-pieces and corrugated tubing. Very little research has been performed on other types of nebulizer delivery systems and there is no substantial information on how effective various nebulizer delivery systems are in terms of the quantity and particle size of aerosolized medication delivered to the patient. In this study the Circulaire and the AeroTee, two devices that rely on bags to store aerosol during patient exhalation, are evaluated and compared to the conventional nebulizer T-piece with corrugated tubing. ⋯ There are clinically important differences between nebulizer delivery systems. When evaluating the optimum means for delivering aerosolized medication, equal consideration should be given to both the brand of nebulizer and the nebulizer delivery system.
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Clinical Trial Controlled Clinical Trial
The effects of passive humidifier dead space on respiratory variables in paralyzed and spontaneously breathing patients.
Passive humidifiers have gained acceptance in the intensive care unit because of their low cost, simple operation, and elimination of condensate from the breathing circuit. However, the additional dead space of these devices may adversely affect respiratory function in certain patients. This study evaluates the effects of passive humidifier dead space on respiratory function. ⋯ Clinicians should be aware that each type of passive humidifier has inherent dead space characteristics. Passive humidifiers with high dead space may negatively impact the respiratory function of spontaneously breathing patients or carbon dioxide retention in paralyzed patients. When choosing a passive humidifier, the device with the smallest dead space, but which meets the desired moisture output requirements, should be selected.
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As an essential hospital facility, the central oxygen supply system should be designed with features allowing backup and/or redundancy in the event of system failure. As part of an organized institutional review of The Cleveland Clinic Foundation hospital inpatient central oxygen supply system, we undertook a survey of all hospitals in two Ohio cities to determine the characteristics of hospital central supply systems. ⋯ (1) Not surprisingly, most of the hospitals in these two urban areas use bulk liquid oxygen systems (with primary and reserve liquid reservoirs) as the main central supply source, with some providing manifolded cylinders as backup. (2) Mishaps regarding the main supply line from the bulk oxygen reservoir were reported by 16% (5/32) of responding institutions. (3) In this context, the fact that most main and reserve tanks were contiguous and fed through a single line to the hospital facility suggests ongoing risk for interruption of an oxygen supply by line mishaps (e.g., street repair). (4) Contingency planning to lessen the risk of an interrupted supply should involve back-up systems with physically separated feed lines, as well as tanks of manifolded cylinders along the course of the main hospital oxygen circuit line.
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Combining a positive expiratory pressure (PEP) device with inhalation of albuterol via metered dose inhaler (MDI) may improve drug delivery to the lung, but may also affect dose availability. ⋯ Interposing the TheraPEP device at the MDI-ACE outlet does not change total dose, drug mass < 4.7 microns, or mass median aerodynamic diameter of MDI albuterol, with either CFC or HFA propellants.
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Editorial Comment
Central oxygen delivery systems: a disaster waiting to happen?