Respiratory care
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Comparative Study
Comparison of Aerosol Delivery by Face Mask and Tracheostomy Collar.
The purpose of this study was to compare the performance of a tracheostomy collar, Wright mask, and aerosol mask attached to a jet nebulizer in facilitating aerosolized medication delivery to the lungs. We also compared albuterol delivery with open versus closed fenestration and determined the effect of inspiratory-expiratory ratio (I:E) on aerosol delivery. ⋯ In an adult tracheostomy model, the tracheostomy collar delivered more aerosol to the bronchi than the Wright or aerosol mask. An I:E of 2:1 caused greater aerosol deposition compared with an I:E of 1:2. During aerosol administration via a tracheostomy collar, closing the fenestration improved aerosol delivery.
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Comparative Study
Performance and Acceptability of Two Self-Inflating Bag-Mask Neonatal Resuscitator Designs.
A self-inflating bag-mask device is specified by international policy guidelines as standard prototype of care for newborn resuscitation. Our hypothesis is that a new bag-mask design would be as effective and easy to use as a standard, self-inflating resuscitation bag-mask. ⋯ The performance and acceptability of the Upright device in this user population suggest that the device may be suitable for effective ventilation by infrequent users in low-resource settings. The Upright device should be tested in such a setting.
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Advanced stages of Duchenne muscular dystrophy (DMD) result in severe lung volume decline and are associated with high respiratory morbidity and mortality. The aim of this study was to investigate whether lung volume decline in subjects with DMD is associated with ventilation inhomogeneity measured with the multiple-breath washout technique. ⋯ Moderate-to-severe lung volume decline in subjects with DMD is associated with ventilation inhomogeneity. Lung clearance index elevation may be the result of altered ventilation geometry or retention of airway secretions in the infection-free DMD subject.
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The dead-space volume (VD) of face masks for metered-dose inhaler treatments is particularly important in infants and young children with asthma, who have relatively low tidal volumes. Data about VD have been traditionally obtained from water displacement measurements, in which masks are held against a flat surface. Because, in real life, masks are placed against the face, VD is likely to differ considerably between masks depending upon their contour and fit. The aim of this study was to develop an accurate and reliable way to measure VD electronically and to apply this technique by comparing the electronic VD of commonly available face masks. ⋯ Computerized techniques provide an innovative and relatively simple way of accurately measuring the VD of face masks applied to digital faces. As determined by computerized measurement using average-size virtual faces, the InspiRx masks had a significantly smaller VD for both small and medium masks compared with the other masks. This is of considerable importance with respect to aerosol dose and delivery time, particularly in young children. (ClinicalTrials.gov registration NCT01274299.).
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Case Reports
High-Flow Nasal Cannula and Aerosolized β Agonists for Rescue Therapy in Children With Bronchiolitis: A Case Series.
Asthma and bronchiolitis are episodic obstructive pulmonary diseases characterized by bronchoconstriction, airway wall inflammation, increased mucus production, and air-flow obstruction. We present the cases of 5 infants treated for acute bronchiolitis with respiratory distress using a combination of high-flow nasal cannula oxygen (HFNC) and an Aerogen nebulizer to deliver aerosolized β-agonist therapy. In all infants, we found that HFNC resulted in a greater heart rate increase than delivery via a facemask. We also found that patients tolerated inhaled therapy better with HFNC than a facemask.