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Copy of THE LUNGS
Transcript of Copy of THE LUNGS
Small volume nebulizers (or SVN) are used to deliver aerosolized particles to the pulmonary system for therapeutic purposes. It is the purpose of this type of therapy to deliver specific medications by having the patient inspire it and have it delivered to a targeted area in the respiratory system.
Particle sizes that are delivered by this method are usually between 1 and 10 micrometers. The droplet size and duration of treatment directly relates to the "flow" being used. If the flow is higher, the particles will be smaller and the treatment will require a shorter time to deliver a full dose.
History of Small Volume Nebulizers
History of Reservoir Devices
Inhalation therapy has been in use for more than 2,000 years. But the idea of delivering the "drug" directly to the infected area didn't come around until much later, some 200 years ago. During the Industrial Revolution, physicians were inventing methods of delivering these therapies as fast as they could. Consumption and asthma were their main concerns at that time, but the idea of treating the lungs through the windpipe lead to the therapies that are still used today.
As far back as 1654, inhalers have been used to treat "the breathless" patient. These devices had a reservoir to hold a liquid and the "drug" that would be steamed or vaporized so that the patient could inhale it directly into the effected area.
Reservoir devices are not a new concept, but they continue to evolve as we advance in our field.
There are a wide variety of devices that Respiratory Therapist use that can be considered Reservoir Devices. Up to this point we have used: Nebulizers, Non-Rebreather masks, Partial-Rebreather masks, MDIs, Resuscitator Bags, and we have learned about Anatomic Reservoir.
Small Volume Nebulizer
Meter Dose Inhaler
Oxygen is a basic gas needed by every cell in the body. Without oxygen, the corporation would not be able to live, and the air that comes into the body comes through us, the lungs.
How are we important employees
in the Human Body Corporation?
The indications for any oxygen therapy device is hypoxemia, trauma/post surgery, and acute myocardial infarction.
There are no contraindications to oxygen therapy when indications are judged to exist.
It's all in the bag!
James Burnett, a doctor in Scotland, reported the first use of bronchodilator therapy in an asthmatic patient in 1903. But the major leap in inhalation therapy didn't happen until the 1950's when the pMDI was revolutionized. Patients could get their "asthma medications" without a prescription. Over-the-counter medications, such as adrenaline and isoprenaline was all the rage. Since it was a non-prescription medication, sales rose over 600% for isoprenaline. Unfortunately, death rates also soared to over 400%.
In 1966, the UK committee on drug safety warned doctors that overuse of isoprenaline could be fatal and pMDI use decreased, resulting in what was called "pre-epidemic" levels for asthma patients. Isoprenaline, as well as adrenaline, were replaced by Salbutamol pMDI and to this day it remains the most frequently prescribed of the Beta-agonists.
Meter Dose Inhalers, or MDI, are more efficent when used with a spacer. This is a reservoir device that "holds" the medication that didn't get inhaled during the first inhilation of the drug. This gives it a "second chance" to get into the airway. This is why spacers are the best method to use with children or elderly patients.
Meter Dose Inhaler
A spacer, or holder, is a reservoir device that reduces the occurrence of the pressurized medication "hitting" the back of the throat and not making it's way into the bronchioles where it is needed.
Valve holding chambers with masks are PERFECT for children because it sends the exhaled gas into the atmosphere instead of mixing it with the medication that is still suspended in the chamber.
of using an MDI: Upper airway inflammation, anesthesia, rhinitis, and systemic disease
MDI with a Spacer/Holder
: Medicinal aerosol therapy is contraindicated when there is a known hypersensitivity or the history of an allergic reaction to a specific pharmacologic agent. Bronchoconstrictions.
contraindications for the use of a spacer with an MDI.
:Improper use of the MDI or malfunction of the device may result in underdosing or overdosing. The propellant in the MDI (Freon) may cause cardiotoxic effects. Large amounts of sputum in the airway may prevent aerosolized medications from getting to the patient's airway.
MDIs and Spacers
Pam Boyer and Becky Sullins
Atrovent HFA, Combivent
Mast Cell Stabilizer Agents
-Short Acting Beta Agonists
ProAir HFA, Proventil HFA, Ventolin, Vospire ER,
Tonalate, Xopenex, Maxair
The anatomical reservoir of the upper airway consists of the nose, the nasopharynx, and the oropharynx. This means that when the patient exhales, there is always a "reserved" amount of usable gas left in the bodies natural reservoir.
Pam and Becky
We've come a long way from where we started.
In the early 1860's, a gentleman named Dr. Emil Seigle improved on an invention by Dr. Walenburg of Germany; it was called Seigle's steam spray inhaler. This apparatus used the Venturi principle to atomize liquid medications, which in theory, became the birth of "nebulizer therapy." (Writing from the late 1870's identify the use of things like turpentine as a Mucolytic.)
One flaw in the earlier versions of nebulizers was that, at the time, doctors did not realize that droplet size was a major factor in getting aerosilized medication to the deeper structures of the lungs.
The indications of using an SVN are: Bronchial hygiene, administration of medications, to hydrate and mobilize secretions, and relief from bronchospasms.
The benefits include: rapid onset of drugs, fewer/less severe systemic side effects due to drugs being delivered directly to the respiratory system, and it is convenient/painless to the patient.
*Ipratropium Bromide and
Mast Cell Stabilizers
Ultra-short Acting Beta Agonists
of using an SVN include Cardiac Arrhythmia, unstable cardiac status, and a hypersensitivity or allergies to the drugs used.
of SVN use is that it has to be held horizontal or it doesn't work properly.
Long Acting Beta Agonists
Short Acting Beta Agonists
Nonrebreather and Partial Rebreather
These two devices may look the same, but they have one major thing that sets them apart. With the partial rebreather, a portion of the patient's exhaled gasses are being "recycled" by mixing in the reservoir bag. Then the patient is able to inhale the "new" mixture of gasses. But with a non-rebreather, the gasses do not mix in the reservoir bag due to the use of the one-way valves. There is one valve for inspiration that is right above the bag, and one for expiration at the side of the face mask. (Note that there is only one expiration valve as a safety feature.)
Non-rebreather and Partial Rebreather