Resp Care
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For both lung and systemic diseases, aerosol delivery of drugs into the lungs can often offer substantial advantages over other routes of administration. In the intensive care unit, however, the artificial airway can be a substantial barrier to aerosol delivery, so clinicians must pay careful attention to the ventilator pattern, the delivery gas humidity/density, the device characteristics, and the circuit/tube properties. When those are optimized, aerosol delivery from a nebulizer or metered-dose inhaler and through an endotracheal tube can begin to approach that seen in a nonintubated patient. Novel approaches, such as generating the aerosol within the airway, offer the opportunity to greatly increase deposition efficiency and focal drug targeting in intubated patients.
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The quality of the aerosol generated by a nebulizer system is a function of its design, operating parameters, and the drug formulation to be aerosolized. The aerosolized drug dose inhaled from a nebulizer is determined by the patient's breathing pattern. The site of deposition of the aerosol in the lung is primarily influenced by the inspiratory flow rate and additionally by the nature of the lung disease. ⋯ The accuracy of these predictions can additionally be improved with the use of breath simulators and standard breath patterns. Breath monitors that capture and feed actual patient breathing patterns into the simulator to mimic nebulizer operation during actual patient use further increase the accuracy of dose estimation. With the vast number of nebulizers available and also in development, a comparison of information obtained from different nebulizers is key in making an informed decision when selecting an aerosol delivery system that can provide an efficacious dose of a particular drug to a specific patient population.
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Portable ventilators require battery power during transport or when alternating current is unavailable. Manufacturers report battery duration at nominal ventilator settings. ⋯ Battery duration differs greatly among the portable ventilators tested. Clinicians must be aware that portable ventilator battery duration is affected by control settings, lung impedance characteristics, and portable ventilator characteristics. Battery duration may be shorter than that reported in the operator's manual for each portable ventilator tested.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of intrapulmonary percussive ventilation and conventional chest physiotherapy for the treatment of atelectasis in the pediatric patient.
Compare intrapulmonary percussive ventilation (IPV) to conventional chest physiotherapy (CPT) and determine their effects on improving atelectasis and static compliance in pediatric patients. ⋯ In the retrospective study a clinically important improvement in atelectasis was seen in patients who received IPV therapy. In the controlled, clinical trial the IPV group showed more clinically important improvement in atelectasis than the CPT group. IPV is a safe and effective method of alternative airway clearance and can be used on patients with artificial airways.
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Comparative Study
Performance of a new screening spirometer at a community health fair.
Compare the results from a new screening spirometer (EasyOne) with the results from a standard laboratory spirometer (Vmax) approved by the American Thoracic Society. ⋯ The new screening spirometer is suitable for clinical use.