Resp Care
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Therapeutic aerosols are generated by pneumatic jet nebulizers, ultrasonic nebulizers, pressurized metered-dose inhalers, and dry powder inhalers. Some of the drug preparations used in these devices are formulated to work with specific devices. Although design improvements in aerosol devices have led to improved lung deposition, decreased oropharyngeal deposition, decreased waste of drug, greater ease of use, and lower environmental impact, optimizing the use of aerosol devices requires patient and caregiver instruction, in combination with proper device use and maintenance. Optimizing aerosol delivery requires knowledge of a number of technical details, and caregivers should stay abreast of the continuing advancement of technologies and techniques associated with aerosol delivery, especially in light of emerging devices and formulations.
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Nebulizers have been used clinically for many years. Despite the increasing use of metered-dose inhalers and dry powder inhalers, it is likely that nebulizers will continue to be used in selected patients. A number of factors affect nebulizer performance, and these should be appreciated by clinicians who use these devices. Several new designs have recently become available that improve the performance of the nebulizer, but their cost-effectiveness remains to be determined.
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Identification of the determinants of efficient aerosol delivery and the specific challenges of aerosol delivery to infants and children can facilitate a systematic approach to optimize aerosol delivery to this population. There are inherent anatomical, physiologic, pathophysiologic, and technical limitations of aerosol efficiency in infants and young children. Nevertheless, one can enhance aerosol efficiency through application of sound principles of aerosol delivery and by exerting control over factors that are amenable to intervention. ⋯ Safety profile, therapeutic efficacy, and efficiency of aerosolized medications delivered to infants and children need to be rigorously studied. This is particularly true for medications with potentially great benefit but possible adverse effects, such as inhaled glucocorticoid therapy in extremely premature infants. Common sense, ethics, and due respect for the same high standard of approval requirements of adults and older children should motivate further research in understanding and improving aerosol delivery in infants and young children.
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Pulmonary and nonpulmonary complications of invasive positive pressure ventilation are well documented in the medical literature. Many of these complications may be minimized by the use of noninvasive ventilation. ⋯ In each of these cases, chest cuirass ventilation improved the patient's clinical condition and decreased the requirement for more invasive therapy. These cases illustrate the need for further clinical evaluation of the use of negative pressure ventilation utilizing a chest cuirass.
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Indwelling arterial lines are commonly used in critical care. To standardize and improve the placement of these devices, we developed and implemented a respiratory therapist-based line placement service. As a measure of the quality of the service, we assessed the success and complications encountered in the first 119 line placement attempts of this new service. ⋯ Initiation of a respiratory therapist-based arterial line placement service resulted in an acceptable cannulation success rate, without complications. Increased experience of the person attempting cannulation correlates with improved success.