Effective Bronchodilator Resuscitation of Children in the Emergency Room: Device or Interface?

Ari, Arzu; Fink, James B.

doi:10.4187/respcare.01375

Cited by 16 publications

(9 citation statements)

References 18 publications

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“…While LOS in the ED was not reduced, patients in the BAN group showed a greater improvement in clinical asthma score, respiratory rate and a significantly lower admission rate with the BAN 38% vs. 57%, (p = 0.03) [12]. In an editorial review of this article, Ari & Fink identified a few confounding variables between the groups (SVN vs. LVN vs. BAN) [12,13]. The authors of the editorial concluded that the method of delivering the dose probably had a direct impact on the outcomes of the study.…”

Section: Discussionmentioning

confidence: 86%

Comparison of bronchodilator administration with vibrating mesh nebulizer and standard jet nebulizer in the emergency department

Dunne

Shortt

2018

The American Journal of Emergency Medicine

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Section: Discussionmentioning

confidence: 86%

Comparison of bronchodilator administration with vibrating mesh nebulizer and standard jet nebulizer in the emergency department

Dunne

Shortt

2018

The American Journal of Emergency Medicine

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“…10 The face mask design is an important aspect of medication delivery in smaller children, regardless of the nebulizer device being used. 31 The mask should be soft, warm, and constructed with flexible material. 32 Generally, smaller patients require smaller masks because with less dead space, the more likely it is that a greater proportion of the dose coming from the device will be inhaled into the lungs.…”

Section: Interface Selectionmentioning

confidence: 99%

Clinical Controversies in Aerosol Therapy for Infants and Children

DiBlasi

2015

Respir Care

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Pediatric patients are different from adult patients with respect to airway anatomy and breathing patterns. They are also incapable of following commands and often reject breathing treatments. For these reasons, aerosol drug delivery is one of the most technically challenging aspects for clinicians providing respiratory care to young children. Improvements in nebulizer technology have provided better delivery options for pediatric patients. This review highlights research related to pediatric nebulizer and interface devices and how they can be used to provide the safest and most efficient treatments with the array of treatment delivery options. Also addressed are clinical controversies and debates in pediatric aerosol science, including drug delivery in crying versus resting infants, pressurized metered-dose inhalers and small-volume nebulizers for bronchodilator administration, continuous nebulization, noninvasive drug delivery options, and optimization of nebulizer performance during infant and large pediatric conventional and high-frequency ventilation.

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“…Intolerance to aerosol administration via mask has been reported in up to 49% of pediatric patients reducing inhaled aerosol to negligible levels .…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8][9] Intolerance to aerosol administration via mask has been reported in up to 49% of pediatric patients reducing inhaled aerosol to negligible levels. 10 The observation that toddlers better tolerate nasal oxygen administration than mask has led to the in-line placement of nebulizers with high-flow nasal cannula (HFNC) devices for transnasal pulmonary delivery. [11][12][13][14] This approach combines benefits of patient's acceptance to receive aerosolized medication for extended dosing periods with the effects of heated humidified gas at the high-flow rate, which has been shown to reduce the patients' work of breathing and improve ventilation.…”

Section: Introductionmentioning

confidence: 99%

In vitro comparison of unit dose vs infusion pump administration of albuterol via high‐flow nasal cannula in toddlers

Fink

2019

Pediatric Pulmonology

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Objectives Transnasal pulmonary aerosol delivery using high‐flow nasal cannula (HFNC) devices has become a popular route of aerosol administration in toddlers. Clinically, albuterol is administered using an infusion pump or unit doses. However, little evidence is available to compare the two administration strategies. Methods A toddler manikin (15 kg) with appropriate anatomic airway was connected with collecting filter to a simulator of distressed breathing. HFNC device with mesh nebulizer placed at the inlet of a humidifier at 37°C, with the gas flow set at 25 and 3.75 L/min. Five milligrams of albuterol was delivered in all experiments. With infusion pump administration, albuterol concentrations of 5 and 1 mg/mL were delivered at 4 and 20 mL/hr for 15 minutes. With unit dose administration, 1 mL (5 mg/mL) and 2 mL (2.5 mg/mL) of albuterol were nebulized. Additional tests with mouth open and nebulizers via mask were using 5 mg/1 mL for mesh nebulizer and 5 mg/3 mL for jet nebulizer (n = 3). The drug was eluted from the filter and assayed with UV spectrophotometry (276 nm). Results The inhaled dose was higher with unit dose than infusion pump administration with gas flows of 25 L/min (2.66 ± 0.38 vs 1.16 ± 0.28%; P = .004) and 3.75 L/min (10.51 ± 1.29 vs 8.58 ± 0.68%; P = .025). During unit dose administration, compared with closed‐mouth breathing, open‐mouth breathing generated a higher inhaled dose at 3.75 L/min and lower inhaled dose at 25 L/min. Compared to the nebulizers via mask with both open and closed‐mouth breathing, nebulization via HFNC at 3.75 L/min generated greater inhaled dose, while HFNC at 25 L/min generated lower inhaled dose. Conclusions During transnasal aerosol delivery, the inhaled dose was higher with medication administrated using unit dose than using an infusion pump.

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Effective Bronchodilator Resuscitation of Children in the Emergency Room: Device or Interface?

Cited by 16 publications

References 18 publications

Comparison of bronchodilator administration with vibrating mesh nebulizer and standard jet nebulizer in the emergency department

Comparison of bronchodilator administration with vibrating mesh nebulizer and standard jet nebulizer in the emergency department

Clinical Controversies in Aerosol Therapy for Infants and Children

In vitro comparison of unit dose vs infusion pump administration of albuterol via high‐flow nasal cannula in toddlers

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