Resp Care
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Assess a prototype inspiratory impedance threshold valve (ITV) designed to enhance vital organ circulation during standard and active compression/decompression cardiopulmonary resuscitation (CPR). ⋯ The prototype ITV passed all performance testing recommended by international guidelines and functioned effectively as intended for use. The animal study results, when combined with recent clinical data, suggest that an ITV inspiratory cracking pressure of 12 cm H(2)O should be sufficient to decrease intrathoracic pressure during the decompression phase of standard CPR. Clinical studies are now underway.
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Over the past few decades, aerosol delivery devices have been relatively inefficient, wasteful, and difficult for patients to use. These drawbacks have been tolerated because the drugs available for inhalation have wide therapeutic margins and steep dose-response curves at low doses. Recently several forces have converged to drive innovation in the aerosol device industry: the ban on chlorofluorocarbon propellants in metered-dose inhalers, the need for more user-friendly devices, and the invention of expensive inhalable therapies for topical and systemic lung delivery. ⋯ Lung deposition ranges from 50 to 80% of the loaded dose, with remarkable reproducibility. AERx has been tested with a variety of drugs, for both topical and systemic delivery, including rhDNase (dornase alfa), insulin, and opioids. These novel devices face competition from other technologies as well as financial and regulatory hurdles, but they both offer a marked improvement in the efficiency of pulmonary drug delivery.
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Most physicians and respiratory therapists are knowledgeable of the use of aerosolized drugs, but many are less familiar with the performance characteristics of the nebulizer. In fact, the general opinion is that the performance of the nebulizer is relatively unimportant. However, there is accumulating evidence that the nebulizer itself does make a difference. ⋯ Third, and perhaps most important, we must gain an increased appreciation for aerosol therapy as a science. The proceedings of this conference do much to synthesize the current state-of-the art related to new nebulizer systems. This provides, in a complete and cogent manner, the scientific basis for which clinicians can improve their knowledge of the new generation of nebulizers.
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Liquid nebulization is a common method of medical aerosol generation. Nebulizers are of 2 types: jet (or pneumatic) small-volume nebulizer, and ultrasonic nebulizer. Jet nebulizers are based on the venturi principle, whereas ultrasonic nebulizers use the converse piezoelectric effect to convert alternating current to high-frequency acoustic energy. ⋯ Ultrasonic nebulizers have the same advantages as jet nebulizers. Ultrasonic nebulizers are more expensive and fragile than jet nebulizers, may cause drug degradation, and do not nebulize suspensions well. Neither type of nebulizer meets the criteria for an ideal inhaler: efficient and quick dose delivery with reproducibility, cost-effectiveness, and no ambient contamination by lost aerosol.
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A therapeutic aerosol benefits the patient only if the medication deposits in the airway. Advances in nebulizer design have made them more efficient and "user friendly," but the greatest problem with administering aerosolized medication continues to be educating patients and caregivers to use aerosol devices properly and consistently. Misuse and nonuse are the greatest impediments to effective aerosol delivery. ⋯ There are many misconceptions about nebulizer use and nebulizer equipment, even in teaching hospitals, and these can have serious consequences when patients do not receive the medication they need. This review discusses how airway physiology, nebulizer technology, and patient education relate to appropriate nebulizer use. Education is critically important, but unfortunately it is often a misunderstood or neglected part of aerosol administration.