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Katiyar SK, Gaur SN, Solanki RN, Sarangdhar N, Suri JC, Kumar R, Khilnani GC, Chaudhary D, Singla R, Koul PA, Mahashur AA, Ghoshal AG, Behera D, Christopher DJ, Talwar D, Ganguly D, Paramesh H, Gupta KB, Kumar T M, Motiani PD, Shankar PS, Chawla R, Guleria R, Jindal SK, Luhadia SK, Arora VK, Vijayan VK, Faye A, Jindal A, Murar AK, Jaiswal A, M A, Janmeja AK, Prajapat B, Ravindran C, Bhattacharyya D, D'Souza G, Sehgal IS, Samaria JK, Sarma J, Singh L, Sen MK, Bainara MK, Gupta M, Awad NT, Mishra N, Shah NN, Jain N, Mohapatra PR, Mrigpuri P, Tiwari P, Narasimhan R, Kumar RV, Prasad R, Swarnakar R, Chawla RK, Kumar R, Chakrabarti S, Katiyar S, Mittal S, Spalgais S, Saha S, Kant S, Singh VK, Hadda V, Kumar V, Singh V, Chopra V, B V. Indian Guidelines on Nebulization Therapy. Indian J Tuberc 2022; 69 Suppl 1:S1-S191. [PMID: 36372542 DOI: 10.1016/j.ijtb.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 06/16/2023]
Abstract
Inhalational therapy, today, happens to be the mainstay of treatment in obstructive airway diseases (OADs), such as asthma, chronic obstructive pulmonary disease (COPD), and is also in the present, used in a variety of other pulmonary and even non-pulmonary disorders. Hand-held inhalation devices may often be difficult to use, particularly for children, elderly, debilitated or distressed patients. Nebulization therapy emerges as a good option in these cases besides being useful in the home care, emergency room and critical care settings. With so many advancements taking place in nebulizer technology; availability of a plethora of drug formulations for its use, and the widening scope of this therapy; medical practitioners, respiratory therapists, and other health care personnel face the challenge of choosing appropriate inhalation devices and drug formulations, besides their rational application and use in different clinical situations. Adequate maintenance of nebulizer equipment including their disinfection and storage are the other relevant issues requiring guidance. Injudicious and improper use of nebulizers and their poor maintenance can sometimes lead to serious health hazards, nosocomial infections, transmission of infection, and other adverse outcomes. Thus, it is imperative to have a proper national guideline on nebulization practices to bridge the knowledge gaps amongst various health care personnel involved in this practice. It will also serve as an educational and scientific resource for healthcare professionals, as well as promote future research by identifying neglected and ignored areas in this field. Such comprehensive guidelines on this subject have not been available in the country and the only available proper international guidelines were released in 1997 which have not been updated for a noticeably long period of over two decades, though many changes and advancements have taken place in this technology in the recent past. Much of nebulization practices in the present may not be evidence-based and even some of these, the way they are currently used, may be ineffective or even harmful. Recognizing the knowledge deficit and paucity of guidelines on the usage of nebulizers in various settings such as inpatient, out-patient, emergency room, critical care, and domiciliary use in India in a wide variety of indications to standardize nebulization practices and to address many other related issues; National College of Chest Physicians (India), commissioned a National task force consisting of eminent experts in the field of Pulmonary Medicine from different backgrounds and different parts of the country to review the available evidence from the medical literature on the scientific principles and clinical practices of nebulization therapy and to formulate evidence-based guidelines on it. The guideline is based on all possible literature that could be explored with the best available evidence and incorporating expert opinions. To support the guideline with high-quality evidence, a systematic search of the electronic databases was performed to identify the relevant studies, position papers, consensus reports, and recommendations published. Rating of the level of the quality of evidence and the strength of recommendation was done using the GRADE system. Six topics were identified, each given to one group of experts comprising of advisors, chairpersons, convenor and members, and such six groups (A-F) were formed and the consensus recommendations of each group was included as a section in the guidelines (Sections I to VI). The topics included were: A. Introduction, basic principles and technical aspects of nebulization, types of equipment, their choice, use, and maintenance B. Nebulization therapy in obstructive airway diseases C. Nebulization therapy in the intensive care unit D. Use of various drugs (other than bronchodilators and inhaled corticosteroids) by nebulized route and miscellaneous uses of nebulization therapy E. Domiciliary/Home/Maintenance nebulization therapy; public & health care workers education, and F. Nebulization therapy in COVID-19 pandemic and in patients of other contagious viral respiratory infections (included later considering the crisis created due to COVID-19 pandemic). Various issues in different sections have been discussed in the form of questions, followed by point-wise evidence statements based on the existing knowledge, and recommendations have been formulated.
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Abazov VM, Abbott B, Acharya BS, Adams M, Adams T, Agnew JP, Alexeev GD, Alkhazov G, Alton A, Alves GA, Antchev G, Askew A, Aspell P, Assis Jesus ACS, Atanassov I, Atkins S, Augsten K, Aushev V, Aushev Y, Avati V, Avila C, Badaud F, Baechler J, Bagby L, Baldenegro Barrera C, Baldin B, Bandurin DV, Banerjee S, Barberis E, Baringer P, Barreto J, Bartlett JF, Bassler U, Bazterra V, Bean A, Begalli M, Bellantoni L, Berardi V, Beri SB, Bernardi G, Bernhard R, Berretti M, Bertram I, Besançon M, Beuselinck R, Bhat PC, Bhatia S, Bhatnagar V, Blazey G, Blessing S, Bloom K, Boehnlein A, Boline D, Boos EE, Borchsh V, Borissov G, Borysova M, Bossini E, Bottigli U, Bozzo M, Brandt A, Brandt O, Brochmann M, Brock R, Bross A, Brown D, Bu XB, Buehler M, Buescher V, Bunichev V, Burdin S, Burkhardt H, Buszello CP, Cafagna FS, Camacho-Pérez E, Carvalho W, Casey BCK, Castilla-Valdez H, Catanesi MG, Caughron S, Chakrabarti S, Chan KM, Chandra A, Chapon E, Chen G, Cho SW, Choi S, Choudhary B, Cihangir S, Claes D, Clutter J, Cooke M, Cooper WE, Corcoran M, Couderc F, Cousinou MC, Csanád M, Csörgő T, Cuth J, Cutts D, da Motta H, Das A, Davies G, Deile M, de Jong SJ, De La Cruz-Burelo E, De Leonardis F, Déliot F, Demina R, Denisov D, Denisov SP, De Oliveira Martins C, Desai S, Deterre C, DeVaughan K, Diehl HT, Diesburg M, Ding PF, Dominguez A, Doubek M, Drutskoy A, Druzhkin D, Dubey A, Dudko LV, Duperrin A, Dutt S, Eads M, Edmunds D, Eggert K, Ellison J, Elvira VD, Enari Y, Eremin V, Evans H, Evdokimov A, Evdokimov VN, Fauré A, Feng L, Ferbel T, Ferro F, Fiedler F, Fiergolski A, Filthaut F, Fisher W, Fisk HE, Forthomme L, Fortner M, Fox H, Franc J, Fuess S, Garbincius PH, Garcia F, Garcia-Bellido A, García-González JA, Gavrilov V, Geng W, Georgiev V, Gerber CE, Gershtein Y, Giani S, Ginther G, Gogota O, Golovanov G, Grannis PD, Greder S, Greenlee H, Grenier G, Gris P, Grivaz JF, Grohsjean A, Grünendahl S, Grünewald MW, Grzanka L, Guillemin T, Gutierrez G, Gutierrez P, Haley J, Hammerbauer J, Han L, Harder K, Harel A, Hauptman JM, Hays J, Head T, Hebbeker T, Hedin D, Hegab H, Heinson AP, Heintz U, Hensel C, Heredia-De La Cruz I, Herner K, Hesketh G, Hildreth MD, Hirosky R, Hoang T, Hobbs JD, Hoeneisen B, Hogan J, Hohlfeld M, Holzbauer JL, Howley I, Hubacek Z, Hynek V, Iashvili I, Ilchenko Y, Illingworth R, Isidori T, Ito AS, Ivanchenko V, Jabeen S, Jaffré M, Janda M, Jayasinghe A, Jeong MS, Jesik R, Jiang P, Johns K, Johnson E, Johnson M, Jonckheere A, Jonsson P, Joshi J, Jung AW, Juste A, Kajfasz E, Karev A, Karmanov D, Kašpar J, Katsanos I, Kaur M, Kaynak B, Kehoe R, Kermiche S, Khalatyan N, Khanov A, Kharchilava A, Kharzheev YN, Kiselevich I, Kohli JM, Kopal J, Kozelov AV, Kraus J, Kumar A, Kundrát V, Kupco A, Kurča T, Kuzmin VA, Lami S, Lammers S, Latino G, Lebrun P, Lee HS, Lee SW, Lee WM, Le X, Lellouch J, Li D, Li H, Li L, Li QZ, Lim JK, Lincoln D, Lindsey C, Linhart R, Linnemann J, Lipaev VV, Lipton R, Liu H, Liu Y, Lobodenko A, Lokajicek M, Lokajíček MV, Lopes de Sa R, Losurdo L, Lucas Rodríguez F, Luna-Garcia R, Lyon AL, Maciel AKA, Macrí M, Madar R, Magaña-Villalba R, Malawski M, Malbouisson HB, Malik S, Malyshev VL, Mansour J, Martínez-Ortega J, McCarthy R, McGivern CL, Meijer MM, Melnitchouk A, Menezes D, Mercadante PG, Merkin M, Meyer A, Meyer J, Miconi F, Minafra N, Minutoli S, Molina J, Mondal NK, Mulhearn M, Mundim L, Naaranoja T, Nagy E, Narain M, Nayyar R, Neal HA, Negret JP, Nemes F, Neustroev P, Nguyen HT, Niewiadomski H, Novák T, Nunnemann T, Oguri V, Oliveri E, Oljemark F, Orduna J, Oriunno M, Osman N, Österberg K, Pal A, Palazzi P, Parashar N, Parihar V, Park SK, Partridge R, Parua N, Pasechnik R, Passaro V, Patwa A, Penning B, Perfilov M, Peroutka Z, Peters Y, Petridis K, Petrillo G, Pétroff P, Pleier MA, Podstavkov VM, Popov AV, Prado da Silva WL, Prewitt M, Price D, Procházka J, Prokopenko N, Qian J, Quadt A, Quinn B, Quinto M, Raben TG, Radermacher E, Radicioni E, Rangel M, Ratoff PN, Ravotti F, Razumov I, Ripp-Baudot I, Rizatdinova F, Robutti E, Rodrigues RF, Rominsky M, Ross A, Royon C, Rubinov P, Ruchti R, Ruggiero G, Saarikko H, Sajot G, Samoylenko VD, Sánchez-Hernández A, Sanders MP, Santoro A, Santos AS, Savage G, Savitskyi M, Sawyer L, Scanlon T, Schamberger RD, Scheglov Y, Schellman H, Schott M, Schwanenberger C, Schwienhorst R, Scribano A, Sekaric J, Severini H, Shabalina E, Shary V, Shaw S, Shchukin AA, Shkola O, Simak V, Siroky J, Skubic P, Slattery P, Smajek J, Snoeys W, Snow GR, Snow J, Snyder S, Söldner-Rembold S, Sonnenschein L, Soustruznik K, Stark J, Stefaniuk N, Stefanovitch R, Ster A, Stoyanova DA, Strauss M, Suter L, Svoisky P, Szanyi I, Sziklai J, Taylor C, Tcherniaev E, Titov M, Tokmenin VV, Tsai YT, Tsybychev D, Tuchming B, Tully C, Turini N, Urban O, Uvarov L, Uvarov S, Uzunyan S, Vacek V, Van Kooten R, van Leeuwen WM, Varelas N, Varnes EW, Vasilyev IA, Vavroch O, Verkheev AY, Vertogradov LS, Verzocchi M, Vesterinen M, Vilanova D, Vokac P, Wahl HD, Wang C, Wang MHLS, Warchol J, Watts G, Wayne M, Weichert J, Welti J, Welty-Rieger L, Williams J, Williams MRJ, Wilson GW, Wobisch M, Wood DR, Wyatt TR, Xie Y, Yamada R, Yang S, Yasuda T, Yatsunenko YA, Ye W, Ye Z, Yin H, Yip K, Youn SW, Yu JM, Zennamo J, Zhao TG, Zhou B, Zhu J, Zich J, Zielinski K, Zielinski M, Zieminska D, Zivkovic L. Odderon Exchange from Elastic Scattering Differences between pp and pp[over ¯] Data at 1.96 TeV and from pp Forward Scattering Measurements. PHYSICAL REVIEW LETTERS 2021; 127:062003. [PMID: 34420329 DOI: 10.1103/physrevlett.127.062003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/19/2021] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Abstract
We describe an analysis comparing the pp[over ¯] elastic cross section as measured by the D0 Collaboration at a center-of-mass energy of 1.96 TeV to that in pp collisions as measured by the TOTEM Collaboration at 2.76, 7, 8, and 13 TeV using a model-independent approach. The TOTEM cross sections, extrapolated to a center-of-mass energy of sqrt[s]=1.96 TeV, are compared with the D0 measurement in the region of the diffractive minimum and the second maximum of the pp cross section. The two data sets disagree at the 3.4σ level and thus provide evidence for the t-channel exchange of a colorless, C-odd gluonic compound, also known as the odderon. We combine these results with a TOTEM analysis of the same C-odd exchange based on the total cross section and the ratio of the real to imaginary parts of the forward elastic strong interaction scattering amplitude in pp scattering for which the significance is between 3.4σ and 4.6σ. The combined significance is larger than 5σ and is interpreted as the first observation of the exchange of a colorless, C-odd gluonic compound.
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