Resp Care
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Metered-dose inhalers with valved holding chambers (MDI-VHCs) have been shown to be equivalent to small-volume nebulizers (SVNs) for the delivery of bronchodilators in children. At Seattle Children's Hospital and Regional Medical Center we sought to implement the conversion from SVN to MDI-delivered albuterol in nonintubated patients receiving intermittent treatments. ⋯ Our program was very successful at promoting the use of MDI-VHC for the administration of albuterol in our pediatric hospital. Duration of stay among patients with asthma did not change during or since the implementation of this program.
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Comparative Study
Handling of inhaler devices in actual pulmonary practice: metered-dose inhaler versus dry powder inhalers.
Handling of inhaler devices such as pressurized metered-dose inhalers (MDIs) and dry-powder inhalers (DPIs) in actual pulmonary practice is not well studied. ⋯ In actual pulmonary clinical practice the majority of patients were unable to use MDI correctly, whereas correct handling of DPI devices was variable. Regular checking of inhalation technique and proper teaching by health care providers is crucial for optimum use of most inhaler devices.
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The Flutter VRP1 device is used for airway clearance. Its performance is based on 4 basic effects: positive expiratory pressure (PEP), forced exhalations (huff), high-frequency airway flow oscillation, and modification of mucus viscoelasticity. The purpose of this study was to determine the flow and angle conditions in which these effects are optimized. ⋯ Positive inclinations optimize positive expiratory pressure and flow-amplitude effects, whereas negative inclinations optimize huff effect. This theoretical knowledge may help optimize the use of the device when applied to different conditions.
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The stethoscope is widely considered to be an unreliable instrument. Many studies document the significant observer variability in its use. Numerous other diagnostic tools are available that are generally regarded to provide more reliable diagnostic information. ⋯ Advances in educational technology have made it possible to impart information on auscultation much more easily than was possible in the past. Contrary to predictions, the stethoscope is not likely to be relegated to the museum shelf in the near future. Computer technology is making it an even more useful clinical instrument.