Pediatric Aerosol Therapy

Berlinski, Ariel

doi:10.4187/respcare.05298

Cited by 32 publications

(22 citation statements)

References 72 publications

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“…The current approach did not differentiate between aerosol that was released prior to inhalation, or aerosol that was possibly exhaled after inhalation. While the use of collection filters has been widely used as a suitable method to determine the inhalation dose [33,34], it might not be truly representative of a simulation of real exhalation. However, since the overall percentage of the inhaled dose is relatively small, it is assumed that the majority of the fugitive emissions consists of aerosol escaping prior to inhalation.…”

Section: Discussionmentioning

confidence: 99%

“…Berlinski [34] reported that the aerosol size fraction exiting the tip of the tracheostomy tube was 1.20 to 1.77 µm. Berlinski [33] reported that aerosol changed its characteristics when travelling through a tracheostomy tube; the effects were more noticeable for nebulised aerosol than metered dose inhalers or valved aerosol reservoirs. Additionally, during simulated adult breathing with gas-flow rates of 10, 40 and 60 L/min, there were comparable trends between the nasal cannula and the tracheostomy interface.…”

Section: Discussionmentioning

confidence: 99%

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Investigation of Fugitive Aerosols Released into the Environment during High-Flow Therapy

et al. 2019

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Background: Nebulised medical aerosols are designed to deliver drugs to the lungs to aid in the treatment of respiratory diseases. However, an unintended consequence is the potential for fugitive emissions during patient treatment, which may pose a risk factor in both clinical and homecare settings. Methods: The current study examined the potential for fugitive emissions, using albuterol sulphate as a tracer aerosol during high-flow therapy. A nasal cannula was connected to a head model or alternatively, a interface was connected to a tracheostomy tube in combination with a simulated adult and paediatric breathing profile. Two aerodynamic particle sizers (APS) recorded time-series aerosol concentrations and size distributions at two different distances relative to the simulated patient. Results: The results showed that the quantity and characteristics of the fugitive emissions were influenced by the interface type, patient type and supplemental gas-flow rate. There was a trend in the adult scenarios; as the flow rate increased, the fugitive emissions and the mass median aerodynamic diameter (MMAD) of the aerosol both decreased. The fugitive emissions were comparable when using the adult breathing profiles for the nasal cannula and tracheostomy interfaces; however, there was a noticeable distinction between the two interfaces when compared for the paediatric breathing profiles. The highest recorded aerosol concentration was 0.370 ± 0.046 mg m−3 from the tracheostomy interface during simulated paediatric breathing with a gas-flow rate of 20 L/min. The averaged MMAD across all combinations ranged from 1.248 to 1.793 µm by the APS at a distance of 0.8 m away from the patient interface. Conclusions: Overall, the results highlight the potential for secondary inhalation of fugitive emissions released during simulated aerosol treatment with concurrent high-flow therapy. The findings will help in developing policy and best practice for risk mitigation from fugitive emissions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Investigation of Fugitive Aerosols Released into the Environment during High-Flow Therapy

et al. 2019

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“…This as noted often, but not always, involves stopping the putative causative drug(s). There are circumstances—such as, for example, therapy of HIV infection with antiretroviral drugs or asthma with albuterol (salbutamol)—during which therapy is continued in the presence of side effects with the expectation that these side effects will diminish or become more tolerable over time …”

Section: The Clinical Approach To Adverse Drug Reactionsmentioning

confidence: 99%

“…There are circumstances-such as, for example, therapy of HIV infection with antiretroviral drugs or asthma with albuterol (salbutamol)-during which therapy is continued in the presence of side effects with the expectation that these side effects will diminish or become more tolerable over time. [61][62][63][64] Management of the ADR in the context of an acute life-threatening event such as anaphylaxis involves a rapid and coordinated response addressing key issues such as airway, breathing, and circulation. 65 In the case of less acute presentations, the primary management strategy is to provide symptomatic relief in the anticipation that the symptoms will diminish and resolve over time.…”

Section: The Clinical Approach To Adverse Drug Reactionsmentioning

confidence: 99%

Adverse Drug Reactions Across the Age Continuum: Epidemiology, Diagnostic Challenges, Prevention, and Treatments

Rieder

2018

The Journal of Clinical Pharma

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Adverse drug reactions (ADRs) are common and important complications of drug therapy for children. The risk for ADRs changes over childhood, as do the nature and types of ADRs. Importantly, the risk and nature of ADRs in children are markedly different from those of adults, and adult data cannot be relied on to guide safe drug therapy in children. There are groups of children, notably those with complex and chronic diseases, who are at substantial risk for ADRs. The evaluation of an undesired effect during therapy is ideally accomplished by an organized approach that is a skill that clinicians who care for children—especially those children at high risk for ADRs must have. Additionally, clinicians as well as drug regulatory agencies and industry need to be both vigilant and astute as well as aware that ADRs in children are often different in nature and frequency from those in adults. The increasing use of pharmacogenomics to guide drug dosing and the increasing number of biological agents will provide new sets of challenges to clinicians over the next decade.

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“…Another area of controversy was the use of Aerosol therapy via HHFNC. The delivery of nebulized medicines is generally affected by flow, type of system used, cannula size, and type of nebulizer used [28]. Respondents didn't specify if certain nebulizing devices were used on their wards while connected to HHFNC.…”

Section: Discussionmentioning

confidence: 99%

A nationwide survey on the use of heated humidified high flow oxygen therapy on the paediatric wards in the UK: current practice and research priorities

2020

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Background: Heated Humidified High Flow Nasal Cannula Oxygen Therapy (HHFNC) is increasingly used on the paediatric wards and High Dependency Units (HDU) for different types of pathologies and different age groups. We aimed to describe current practice related to the use of HHFNC on the paediatric wards and HDUs, weaning practices and preferred outcome measures for future research. Methods: We carried out a cross-sectional online survey of UK paediatric consultants or their delegates working on the paediatric wards. Descriptive analysis of their geographical, and organizational characteristics, their specialties, and their level of experience was investigated. Reasons for HHFNC initiation, weaning criteria, patients' characteristics and their primary pathologies were also analysed. Results: Participation of 218 paediatricians from 81 hospitals (Median: 2.7, Range: 1-11) was registered. HHFNC was provided in most of the surveyed hospitals (93%, 75/81). A High Dependency Unit (HDU) was available in 47 hospitals (58%); less than a third of those have a dedicated paediatrician. Decisions around HHFNC were made solely by paediatricians in (75%) of the cases, mostly at hospitals with no HDU compared to those with dedicated HDUs (70.3% VS 36.6, 95%CI:22.6-50.4%, P < .001). HHFNC was reported by nearly two-thirds (68%) of the practitioners who used it on the wards to be as effective or superior to CPAP (Continuous Positive Airway Pressure) with fewer complications. Failure rate while on HHFNC was identified as the most important outcome measure in any future research followed by the length of need for HHFNC support (37.1, and 28% respectively). Conclusion: This survey showed support for developing paediatric-specific national guidance on the use of HHFNC on the wards. Our list of defined research priorities may help guide further collaborative research efforts in this field.

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Pediatric Aerosol Therapy

Cited by 32 publications

References 72 publications

Investigation of Fugitive Aerosols Released into the Environment during High-Flow Therapy

Investigation of Fugitive Aerosols Released into the Environment during High-Flow Therapy

Adverse Drug Reactions Across the Age Continuum: Epidemiology, Diagnostic Challenges, Prevention, and Treatments

A nationwide survey on the use of heated humidified high flow oxygen therapy on the paediatric wards in the UK: current practice and research priorities

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