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Published on: January 17, 2011
Survey of aerosol delivery techniques to spontaneously breathing tracheostomized children
L Denise Willis1, Ariel Berlinski
1Pediatric Pulmonary Medicine Division, Arkansas Children's Hospital, Little Rock, Arkansas, USA.
Insights
Practices for delivering inhaled aerosols to tracheostomized children vary widely. This survey found no standard recommendations, highlighting the need for further research to guide clinical practice for aerosol therapy in pediatric patients.
Area of Science:
- Pediatric Respiratory Medicine
- Inhaled Therapy Delivery
- Clinical Practice Variation
Background:
- Therapeutic inhaled aerosols are crucial for spontaneously breathing tracheostomized children.
- Current practices lack standardized recommendations for device and drug formulation selection.
- Significant variability in aerosol delivery modalities is anticipated among institutions.
Purpose of the Study:
- To survey current practices in aerosol delivery to spontaneously breathing tracheostomized children.
- To identify factors influencing the choice of aerosol delivery devices and medications.
- To assess the extent of practice variation across different healthcare institutions.
Main Methods:
- Survey of respiratory care departments in US pediatric pulmonology training institutions.
- Data collection on device usage (metered-dose inhalers, nebulizers, dry powder inhalers), delivery techniques (assisted/unassisted), interfaces, and medications.
- Inquiry into factors influencing delivery method selection, particularly patient cooperation.
Main Results:
- High participation rate (81%) from children's hospitals.
- Widespread use of metered-dose inhalers (92%) and nebulizers (97%).
- Tracheostomy aerosol masks were the most common interface (89%); assisted techniques were employed by 68% of institutions. Common medications included antibiotics, corticosteroids, and beta-agonists. Patient cooperation was the primary factor influencing method choice.
Conclusions:
- Significant variation exists in current aerosol delivery practices for tracheostomized pediatric patients.
- Lack of standardized protocols necessitates further investigation.
- In vivo and in vitro studies are required to establish evidence-based clinical recommendations for inhaled aerosol therapy.
Background:
Therapeutic inhaled aerosols are often delivered to spontaneously breathing tracheostomized children. Although aerosol delivery can be affected by several factors, no recommendations for device/drug formulation choice are available. We hypothesized that practice modalities will vary among different institutions.
Methods:
The respiratory care departments in institutions in the United States that train pediatric pulmonologists were surveyed regarding their practices of delivering aerosols to spontaneously breathing tracheostomized children. Characteristics of the institution; use of metered-dose inhalers (MDIs), nebulizers, and dry powder inhalers; use of a resuscitation bag to aid aerosol delivery (assisted); types of medication used; and factors affecting choice of delivery method were recorded.
Results:
Of the invited institutions, 81% (38/47) participated, with 68% of them being freestanding children's hospitals. MDIs were used by 92% of the institutions surveyed, with similar use of unassisted (32%, with 83% of them using spacers), assisted (34%, with 100% of them using non-valved spacers), and both techniques (34%). Nebulizers were used by 97% of the institutions surveyed, with all using unassisted and 32% also using assisted technique. Tracheostomy aerosol mask was the most commonly used interface (89%). Assisted technique for either MDI or nebulizer was used by 68% of the institutions surveyed, with similar use of flow-inflating bag, self-inflating bag, and both devices. Types of inhaled medications utilized by surveyed institutions included aerosolized antibiotics (82%), corticosteroids (100%), short-acting β agonists (100%), combination therapy (32%), and mucolytics (84%). Dry powders were not used. Patient cooperation was the most frequent and single most important factor influencing the choice of delivery method.
Conclusions:
A wide variation in practice of delivering aerosols to spontaneously breathing tracheostomized children was noted. In-vivo and in-vitro studies are needed to support clinical recommendations.
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