Resp Care
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Comparative Study
Influence of nebulizer type, position, and bias flow on aerosol drug delivery in simulated pediatric and adult lung models during mechanical ventilation.
The effectiveness of aerosol drug delivery during mechanical ventilation is influenced by the patient, ventilator, and nebulizer variables. The impact of nebulizer type, position on the ventilator circuit, and bias flow on aerosol drug delivery has not been established for different age populations. ⋯ During simulated mechanical ventilation in pediatric and adult models, bias flow and nebulizer type and position impact aerosol drug delivery.
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The position of the jet or ultrasonic nebulizer in the ventilator circuit impacts drug delivery during mechanical ventilation, but has not been extensively explored, and no study has examined all of the commonly used nebulizers. ⋯ During mechanical ventilation the optimal drug delivery efficiency depends on the aerosol generator, the ventilator circuit, and the aerosol generator position.
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The effects of intermittent positive-pressure breathing (IPPB) and abdominal belt on regional lung ventilation in neuromuscular patients are unknown. We conducted a prospective physiologic short-term study in stable neuromuscular patients to determine the effects of IPBB, with and without abdominal belt, on regional lung ventilation. ⋯ In patients with neuromuscular disease, supine IPPB treatments, with or without abdominal belt, increased ventilation to anterior lungs regions, compared to the left-lateral and right-lateral positions. Global ventilation 3 hours after IPPB treatments remained higher than at baseline and was best preserved with the use of an abdominal belt.
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The rise in inspiratory flow is important during patient-triggered ventilation. Many ventilators incorporate a function to control the time to reach the targeted airway pressure (inspiratory rise time). However, it has not been clarified how inspiratory rise time affects inspiratory work load under various ventilator settings. In a bench study we investigated the effect of inspiratory rise time on inspiratory work load during pressure-support ventilation (PSV). ⋯ Short inspiratory rise time decreased inspiratory work load, regardless of the pressure-support level, triggering sensitivity, or inspiratory drive. Inspiratory work load can be maximally lowered by a combination of a short inspiratory rise time, a sharp triggering sensitivity, and a high inspiratory pressure-support level for a given patient's inspiratory effort.