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Buendía JA, Patiño DG. Impact of the updating of clinical guidelines for RSV bronchiolitis on the use of diagnostic testing and medications in tertiary hospitals in Colombia. Pan Afr Med J 2022; 42:219. [PMID: 36258899 PMCID: PMC9569147 DOI: 10.11604/pamj.2022.42.219.24876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/16/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction the incidence of Respiratory Syncytial Virus (RSV) infection and their variability in the clinical management, make this disease a candidate for monitoring adequate use of resources. The objective of this study was to evaluate the impact of the updating of clinical guidelines for RSV bronchiolitis on the use of diagnostic testing and medications in tertiary hospitals in Colombia. Methods we performed a cross-sectional study, evaluating the frequencies of drug prescription and medical tests, before (January-December 2016) and after (January to December 2019) of updating and dissemination of a new protocol for the treatment of RSV bronchiolitis in two tertiary hospitals in Colombia. Results a total of 108 patients with RSV bronchiolitis were included. The demographic characteristics and clinical manifestations were similar in both groups. The length of hospital stays was similar in both groups. We did not find statistically significant differences in the frequency of medical tests. There was a decrease in the use of salbutamol (67.3% pre-protocol vs 51.8% post-protocol; P < .01). There were also significant reductions in the use of nebulized hypertonic saline solution (91.6% vs 82.6% P = 0.004). Conclusion our results demonstrate that the updating of clinical guidelines for RSV bronchiolitis was effective, as it achieved decreases in the use of bronchodilators and nebulized hypertonic saline solution. It is necessary to continue developing new strategies targeted to increase adherence to guidelines and evaluate the impact on the use of resources.
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Affiliation(s)
- Jefferson Antonio Buendía
- Grupo de Investigación en Farmacología y Toxicología, Centro de Información y Estudio de Medicamentos y Tóxicos (CIEMTO), Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia,,Corresponding author: Jefferson Antonio BuendÍa, Grupo de InvestigaciÓn en FarmacologÍa y toxicologÍa, Centro de InformaciÓn y Estudio de Medicamentos y TÓxicos (CIEMTO), Departamento de FarmacologÍa y ToxicologÍa, Facultad de Medicina, Universidad de Antioquia, MedellÍn, Colombia.
| | - Diana Guerrero Patiño
- Grupo de Investigación en Farmacología y Toxicología, Centro de Información y Estudio de Medicamentos y Tóxicos (CIEMTO), Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia,,Hospital Infantil Concejo de Medellin, Medellin, Colombia
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The Role of Seawater and Saline Solutions in Treatment of Upper Respiratory Conditions. Mar Drugs 2022; 20:md20050330. [PMID: 35621981 PMCID: PMC9147352 DOI: 10.3390/md20050330] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 02/07/2023] Open
Abstract
The history of saline nasal irrigation (SNI) is indeed a long one, beginning from the ancient Ayurvedic practices and gaining a foothold in the west at the beginning of the 20th century. Today, there is a growing number of papers covering the effects of SNI, from in vitro studies to randomized clinical trials and literature overviews. Based on the recommendations of most of the European and American professional associations, seawater, alone or in combination with other preparations, has its place in the treatment of numerous conditions of the upper respiratory tract (URT), primarily chronic (rhino)sinusitis, allergic rhinitis, acute URT infections and postoperative recovery. Additionally, taking into account its multiple mechanisms of action and mounting evidence from recent studies, locally applied seawater preparations may have an important role in the prevention of viral and bacterial infections of the URT. In this review we discuss results published in the past years focusing on seawater preparations and their use in clinical and everyday conditions, since such products provide the benefits of additional ions vs. saline, have an excellent safety profile and are recommended by most professional associations in the field of otorhinolaryngology.
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Teper A, Kofman C, Alchundia Moreira J, Köhler T, García Bournissen F. Bronchodilator response to albuterol nebulized with hypertonic saline in asthmatic children. Pediatr Pulmonol 2021; 56:3714-3719. [PMID: 34499820 DOI: 10.1002/ppul.25653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Asthma is distinguished by bronchial obstruction reversible by bronchodilators. The first-line treatment for asthmatic exacerbations is the use of inhaled beta-agonists, by pressurized metered-dose inhalers or nebulized with normal saline solution (NSS). There are no reports of nebulized beta agonists' efficacy in asthmatic children when administered with hypertonic saline solution (HSS). OBJECTIVE To evaluate bronchodilator responses (BDR) to albuterol nebulized with 3%-HSS in asthmatic children, compared to albuterol nebulized with NSS. POPULATION AND METHODS In a prospective, experimental, double-blind, randomized clinical study, children with a confirmed diagnosis of asthma with mild or moderate bronchial obstruction (FEV1 40%-79% of predicted) were randomized to receive a nebulization with 2.5 mg of albuterol diluted in 3 cc of 3%-HSS or NSS (0.9%), by means of a jet nebulizer. After 30 min, the BDR was assessed. RESULTS Fifty patients (mean age 12.0 ± 3 years, 29 males) were enrolled; 25 were randomized to the 3%-HSS group (FEV1 65.2% ± 10) and 25 to the NSS group (FEV1 69.1% ± 7.1). The BDR of FEV1 was 41.2% (SD: ±20.1; 95% confidence interval [CI]: 35.1-50.4) and 17.3% (SD: ±19.4; 95% CI: 9.7-24.9) (p < .0001) and of maximum mid-expiratory flow was 130% (SD: ±90.8; 95% CI: 94.6-166) and 69.8% (SD: ±72.5; 95% CI: 41.4-98.2) (p < .01), for the 3%-HSS and NSS groups, respectively. CONCLUSION Albuterol produces a greater BDR when nebulized with 3%-HSS compared to NSS in asthmatic children with mild or moderate bronchial obstruction.
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Affiliation(s)
- Alejandro Teper
- Centro Respiratorio Dr Alberto Alvarez, Hospital de Niños Dr Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | - Carlos Kofman
- Centro Respiratorio Dr Alberto Alvarez, Hospital de Niños Dr Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | - Jessica Alchundia Moreira
- Centro Respiratorio Dr Alberto Alvarez, Hospital de Niños Dr Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | - Teresa Köhler
- Centro Respiratorio Dr Alberto Alvarez, Hospital de Niños Dr Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | - Facundo García Bournissen
- Centro Respiratorio Dr Alberto Alvarez, Hospital de Niños Dr Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina.,Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Ramalingam S, Graham C, Oatey K, Rayson P, Stoddart A, Sheikh A, Cunningham S. Study protocol of the Edinburgh and Lothian Virus Intervention Study in Kids: a randomised controlled trial of hypertonic saline nose drops in children with upper respiratory tract infections (ELVIS Kids). BMJ Open 2021; 11:e049964. [PMID: 33952557 PMCID: PMC8103393 DOI: 10.1136/bmjopen-2021-049964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/02/2021] [Accepted: 03/16/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Edinburgh and Lothians' Viral Intervention Study Kids is a parallel, open-label, randomised controlled trial of hypertonic saline (HS) nose drops (~2.6% sodium chloride) vs standard care in children <7 years of age with symptoms of an upper respiratory tract infection (URTI). METHODS AND ANALYSIS Children are recruited prior to URTI or within 48 hours of developing URTI symptoms by advertising in areas such as local schools/nurseries, health centres/hospitals, recreational facilities, public events, workplaces, local/social media. Willing parents/guardians, of children <7 years of age will be asked to contact the research team at their local site. Children will be randomised to either a control arm (standard symptomatic care), or intervention arm (three drops/nostril of HS, at least four times a day, until 24 hours after asymptomatic or a maximum of 28 days). All participants are requested to provide a nasal swab at the start of the study (intervention arm: before HS drops) and then daily for four more days. Parent/guardian complete a validated daily diary, an end of illness diary, a satisfaction questionnaire and a wheeze questionnaire (day 28). The parent/guardian of a child in the intervention arm is taught to prepare HS nose drops. Parent/guardian of children asymptomatic at recruitment are requested to inform the research team within 48 hours of their child developing an URTI and follow the instructions already provided. The day 28 questionnaire determines if the child experienced a wheeze following illness. Participation in the study ends on day 28. ETHICS AND DISSEMINATION The study has been approved by the West of Scotland Research Ethics Service (18/WS/0080). It is cosponsored by Academic and Clinical Central Office for Research and Development-a partnership between the University of Edinburgh and National Health Service Lothian Health Board. The findings will be disseminated through peer-reviewed publications, conference presentations and via the study website. TRIAL REGISTRATION NUMBER NCT03463694.
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Affiliation(s)
- Sandeep Ramalingam
- Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Catriona Graham
- Edinburgh Clinical Research Facility, The University of Edinburgh, Edinburgh, UK
| | - Katherine Oatey
- Edinburgh Clinical Trials Unit, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Phillip Rayson
- Edinburgh Clinical Trials Unit, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Andrew Stoddart
- Edinburgh Clinical Trials Unit, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Centre of Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Steve Cunningham
- Centre for Inflammation Research, Department of Child Life and Health, Royal Hospital for Children and Young People, Edinburgh, UK
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Tatzber F, Resch U, Lindschinger M, Cvirn G, Wonisch W. Improved protection of filtering facepiece through inactivation of pathogens by hypertonic salt solutions - A possible COVID-19 prevention device. Prev Med Rep 2020; 20:101270. [PMID: 33282639 PMCID: PMC7695550 DOI: 10.1016/j.pmedr.2020.101270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/07/2020] [Accepted: 11/19/2020] [Indexed: 02/06/2023] Open
Abstract
The filtering facepiece operates through filtration without the ability to kill the viruses. If the filtration might be combined with antiviral agents simultaneously in the masks, this would be much more efficient during the use of these masks and against cross-infection after being discarded. For centuries, sodium chloride (NaCl) contributes to inhibiting pathogens on various occasions. If aerosol with infectious agents reaches the filtering face-piecé surface of the filtering face-piece, coated with hypertonic saline, they become attracted by hygroscopic salt crystals. Proteins and nucleic acids lose their structural integrity and become inactivated concerning their infectious properties. We provide further evidence for cell growth inhibition with hypertonic saline in yeast cells comprising a defending cell wall. Proliferation was inhibited in a concentration-dependent manner, i.e., above 50 g/L, yeast cell proliferation was completely blocked. At a NaCl concentration of 100 g/L, even decomposition of the original inoculated organisms was observed. Therefore, we conclude that hypertonic saline- coated filtering facepiece might strongly reduce the numbers of infectious particles on their surfaces and thus protect mask carriers efficiently from infections.
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Affiliation(s)
- Franz Tatzber
- Otto Loewi Research Center, Division of Immunology and Pathophysiology, Medical University of Graz, Austria
| | - Ulrike Resch
- Department of Vascular Biology and Thrombosis Research, Medical University of Vienna, Austria
| | - Meinrad Lindschinger
- Institute of Nutritional and Metabolic Diseases, Outpatient Clinic Laßnitzhöhe, Austria
| | - Gerhard Cvirn
- Otto Loewi Research Center, Division of Physiological Chemistry, Medical University of Graz, Austria
| | - Willibald Wonisch
- Otto Loewi Research Center, Division of Physiological Chemistry, Medical University of Graz, Austria
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Buendía JA, Acuña-Cordero R. The cost-effectiveness of hypertonic saline inhalations for infant bronchiolitis. BMC Health Serv Res 2020; 20:1001. [PMID: 33138807 PMCID: PMC7607832 DOI: 10.1186/s12913-020-05814-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/12/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pharmacological treatment for bronchiolitis is primarily supportive because bronchodilators, steroids, and antibiotics, show little benefit. Clinical studies have suggested that nebulized 3% hypertonic solution is useful for infants with bronchiolitis. This study aims to evaluate the cost-effectiveness of the HS inhalations in infant bronchiolitis in a tropical country. METHODS Decision tree analysis was used to calculate the expected costs and QALYs. All cost and use of resources were collected directly from medical invoices of 193 patient hospitalized with diagnosis of bronchiolitis in tertiary centers, of Rionegro, Colombia. The utility values applied to QALYs calculations were collected from the literature. The economic analysis was carried out from a societal perspective. RESULTS The model showed that nebulized 3% hypertonic solution, was associated with lower total cost than controls (US $200vs US $240 average cost per patient), and higher QALYs (0.92 vs 0.91 average per patient); showing dominance. A position of dominance negates the need to calculate an incremental cost-effectiveness ratio. CONCLUSION The nebulized 3% hypertonic solution was cost-effective in the inpatient treatment of infant bronchiolitis. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other tropical countries.
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Affiliation(s)
- Jefferson Antonio Buendía
- Grupo de Investigación en Farmacología y Toxicología (INFARTO). Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad de Antioquia, Carrera 51D #62-29, Medellín, Colombia
| | - Ranniery Acuña-Cordero
- Departamento de Neumología Pediátrica, Hospital Militar Central, Departamento de Pediatría, Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá, Colombia
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Nebulized hypertonic saline 3% for 1 versus 3 days in hospitalized bronchiolitis: a blinded non-inferiority randomized controlled trial. BMC Pediatr 2019; 19:417. [PMID: 31699072 PMCID: PMC6839239 DOI: 10.1186/s12887-019-1804-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 10/24/2019] [Indexed: 11/16/2022] Open
Abstract
Background The use and optimal duration of treatment with nebulized hypertonic saline (HS) in infants hospitalized for acute bronchiolitis is unclear. The objective was to compare the efficacy of 1 versus 3 days of nebulized 3% HS at 72 h of treatment. We conducted a blinded non-inferiority randomized controlled trial including infants aged less than 12 months old, hospitalized for a moderate bronchiolitis. Methods Nebulisations of 3% HS for 1 day were followed by either the continuation of 3% HS (HS3d group) or switched to 0.9% normal isotonic saline (HS1d group) for 2 days Randomization was performed according to a predefined list with a 1:1 ratio, obtained with a random generator number with blocks.. Main outcome was mean Wang clinical severity score (CSS) after 72 h of treatment. Results One hundred sixteen infants (HS1d n = 59 and HS3d n = 57), were included over two epidemic seasons from 2014 to 2016, but recruitement did not reach the planned sample size. The difference for the Wang CSS score in the HS3d vs HS1d group was 0.71 [IC 90% 0.1; 1.3], above the precluded value of 0.4 set in the protocol defining the non-inferiority of shorter treatment duration. Clinical remission was more rapidly obtained in the HS3d than in HS1d (2.3 ± 1.6 vs 2.9 ± 1.4 days, p = 0.04), with a non-significant tendency for less need of nutritional support and supplemental oxygen in HS3d group. Clinical worsening and treatment intolerance were similar in the 2 groups. Conclusions Despite being underpowered, results seem not to be in favour of reducing the duration of nebulised HS treatment from 3 to 1 day in acute moderate bronchiolitis. Trial registration Clinical trials NCT 02538458, October 2014.
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Stobbelaar K, Kool M, de Kruijf D, Van Hoorenbeeck K, Jorens P, De Dooy J, Verhulst S. Nebulised hypertonic saline in children with bronchiolitis admitted to the paediatric intensive care unit: A retrospective study. J Paediatr Child Health 2019; 55:1125-1132. [PMID: 30645038 DOI: 10.1111/jpc.14371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/05/2018] [Accepted: 12/12/2018] [Indexed: 11/29/2022]
Abstract
AIM Bronchiolitis is one of the most common lower respiratory tract infections in young children, associated with significant morbidity, but limited therapeutic options. Nebulised hypertonic saline (HS) has been a supportive treatment until current guidelines advised against its routine use. Accordingly, the University Hospital of Antwerp recently changed their policies to stop using it, allowing us to evaluate retrospectively if HS influences the duration of respiratory support. Because, to our knowledge, the effect of HS on children with severe bronchiolitis admitted to a paediatric intensive care unit (PICU) has not been studied yet, we aimed to investigate the effect in this specific patient group. METHODS Retrospective study including children up to the age of 2, admitted to the PICU with bronchiolitis from October 2013 until March 2016. The primary end point is the duration of respiratory support, including high flow nasal cannula, continuous positive airway pressure and invasive ventilation. RESULTS A total of 104 children admitted to the PICU with bronchiolitis were included, with an average age of 3.4 months. In respiratory syncytial virus (RSV) positive patients, the use of nebulised HS was correlated with a decrease in the duration of respiratory support and the length of stay by factors 0.72 (P = 0.01) and 0.81 (P = 0.04), respectively. CONCLUSIONS A significant correlation was found between the use of HS and a decreased duration of respiratory support and admission in the PICU in patients with RSV bronchiolitis. This finding may warrant new prospective studies investigating HS specifically in children with severe bronchiolitis.
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Affiliation(s)
- Kim Stobbelaar
- Department of Paediatrics, University of Antwerp, Edegem, Belgium
| | - Mirjam Kool
- Department of Paediatrics, University of Antwerp, Edegem, Belgium
| | | | | | - Philippe Jorens
- Paediatric Intensive Care Unit, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Jozef De Dooy
- Paediatric Intensive Care Unit, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Stijn Verhulst
- Department of Paediatrics, University of Antwerp, Edegem, Belgium
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Valencia-Ramos J, Arnaez J, Benito JM, Mirás A, Ochoa C, Beltrán S. A comparative in vitro study of standard facemask jet nebulization and high-flow nebulization in bronchiolitis. Exp Lung Res 2019; 45:13-21. [PMID: 31007091 DOI: 10.1080/01902148.2019.1599084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aim of Study: The use of a nebulizer paired with high-flow nasal cannulas (HFNC) has been proposed for drug delivery in bronchiolitis. Particle size nebulized is a relevant factor determining the efficacy of the nebulization. We replicated in vitro the theoretical parameters most widely used in bronchiolitis and we compared the size of the droplet nebulized with a standard nebulizer and a nebulizer integrated into HFNC. Materials and Methods: We used laser diffraction to analyze the particle size nebulized (volume median diameter Dv50). The standard system was a jet nebulizer connected to a facemask with a flow rate of 8 L/min (JN). Three designs were used as nebulizers integrated into HFNC: a vibrating mesh nebulizer set 1) before (HFNC-BH) and 2) after (HFNC-AH) the humidifier, and 3) a jet nebulizer connected before the nasal cannula (HFNC-BNC). HFNC was used with neonatal (3-8 L/min) and infant cannulas (8-15 L/min). Results: Droplet size was similar among the three drugs studied. A lower particle size was obtained when using the nebulization system integrated into HFNC compared to the standard nebulizer, regardless of the flow rate and the nasal cannula used when the position of the nebulizer was before the nasal cannula (p < 0.05): 6.89 µm (JN), 2.49 µm (HFNC-BNC 3 L/min), 2.59 µm (HFNC-BNC 5 L/min), 2.44 µm (HFNC-BNC 8 L/min), 3.22 µm (HFNC-BNC 10 L/min), 3.23 µm (HFNC-BNC 13 L/min), 3.16 µm (HFNC-BNC 15 L/min). The particle size was lower in HFNC-BF compared to the HFNC-AH using neonatal nasal cannula (3-8 L/min) (p < 0.05). Conclusion: The use of a nebulizer integrated with HFNC has shown promising results in an experimental scenario of bronchiolitis. The particle size achieved with the nebulizer placed before the humidifier is equivalent to the one obtained via conventional nebulization, and it is even smaller when the integrated nebulizer is placed before the nasal cannulas.
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Affiliation(s)
- Juan Valencia-Ramos
- a Paediatric Intensive Care Unit , Hospital Universitario de Burgos , Burgos , Spain
| | - Juan Arnaez
- b Department of Neonatology , Hospital Universitario de Burgos , Burgos , Spain
| | - José Manuel Benito
- c Chemical Engineering Division, Department of Biotechnology and Food Science , Universidad de Burgos , Burgos , Spain
| | - Alicia Mirás
- a Paediatric Intensive Care Unit , Hospital Universitario de Burgos , Burgos , Spain
| | - Carlos Ochoa
- d Department of Investigation Unit , Hospital Virgen de la Concha, Escuela Universitaria de Enfermería de Zamora , Zamora , Spain
| | - Sagrario Beltrán
- c Chemical Engineering Division, Department of Biotechnology and Food Science , Universidad de Burgos , Burgos , Spain
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Icard BL, Rubio E. The role of mucoactive agents in the mechanically ventilated patient: a review of the literature. Expert Rev Respir Med 2017; 11:807-814. [PMID: 28737047 DOI: 10.1080/17476348.2017.1359090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The management of airway secretions in the mechanically ventilated patient is a routine task throughout all intensive care units. The current treatment strategies are primarily based on anecdotal experiences rather than statistical evidence. Areas covered: This review article evaluates the data from published trials surrounding mucoactive agents and their use in the critically ill patient population. We completed an extensive search through PUBMED and CINAHL via EBSCO, along with the Cochran library to find all trials using mucoactive agents in the critically ill patient population. Expert commentary: Overall, the role of mucoactive agents in the intensive care unit is a field within pulmonary critical care that is in need of evidence-based recommendations. We feel that there is great opportunity for investigators to evaluate different mucoactive therapies in this patient population and to determine their effect on clinical outcomes.
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Affiliation(s)
- Bradley L Icard
- a Department of Pulmonary, Critical Care, and Sleep Medicine , Carilion Clinic - Virginia Tech Carilion School of Medicine , Roanoke , VA , USA
| | - Edmundo Rubio
- a Department of Pulmonary, Critical Care, and Sleep Medicine , Carilion Clinic - Virginia Tech Carilion School of Medicine , Roanoke , VA , USA
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