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Mask versus Mouthpiece Nebulizer treatments
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Picture of JeffWhitnack
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I don't have the citation handy, but one study I recall did show that a mouthpiece delivered more drug than a nasal treatment. But I would suspect that if this were done on "normals"----ones not SOB and driven to mouth breath, ones not so "tight" that the airway route is perhaps less efficacious than IV...
Perhaps then the nasal route (mask and patient breathing through nose and mouth) might be an inadvertent beneficial way of administering the drug.

From the article from recent RC Journal by Tim o-pt Holt July 2007.....

Intravenous administration of 2 adrenergics has also been reported in patients with severe bronchospasm unresponsive to inhaled bronchodilators. Roberts et al reported
that intravenous aminophylline, but not intravenous albuterol, significantly reduced duration of hospital stay in a group of 40 children with severe asthma.7 Sellers and Messahel reported on the administration of intravenous salmeterol in 7 patients with severe asthma who were unresponsive to inhaled albuterol. They administered 5-g/kg
boluses of albuterol to children and 250-g boluses of albuterol to young adults. Signs of improvement included decreased wheezing, decreased coughing, and decreased use of accessory muscles, ability to talk, and increased arterial oxygen saturation. They concluded that immediate care of acute severe asthma should include the use of intravenous albuterol to achieve a predictable delivery of
2 agonist to bronchial smooth muscle, given that in severe asthma, the airways are narrowed such that aerosolized particles may not reach the small airways.8

The British Thoracic Society stated that the role of intravenous B2 agonists in addition to nebulized treatment remains unclear. They state that continuous intravenous infusion should be considered when there is uncertainty about reliable inhalation or for severe refractory asthma." They recommend a 15-g/kg bolus of intravenous albuterol early in treatment as an adjunct in severe cases.9
The recent Global Initiative for Asthma guidelines include the use of intravenous 2 agonists in patients with poor response (peak expiratory flow 30% of predicted, severe symptoms, hypercapnia and hypoxemia), and to
admit the patient to the intensive care unit.10"

As Light points out we've all seen Docs and others (including other RT's) think that giving Bronchodilators purely to treat hypoxemia is a good thing to do. When we argue against this a standard retort is usually "well it can't hurt". But the "joke" is on us, indeed it has cost the lives of clinicians around the globe...

That has been postulated in a NEJM artticle as to how SARS spread in Hong Kong--the index patient was given a lot of Albuterol tx's. Otherwise it would be curious as to why SARS seemed to have a prediliction for erupting in hospitals more than in the community. Finally the "bugs" are starting to take advantage of our foolishness.
 
Posts: 171 | Location: Palo Alto, CA USA | Registered: November 14, 2002Reply With QuoteReport This Post
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Picture of light
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Jeff,
I love the response "it can't hurt". This normally sends me on a 15-20 min rant on what is good for, but we will save that for another post.

I have been searching for a article showing mouthpiece more effective than mask but have not found one, if you do please post here. All thatI have found has been peds studies and most of them did not show a benifit of mouthpiece over mask, but rather the side effects were less with mouthpiece. Draw what you want from that, but none that I saw showed a subjective or objective clinical change in dyspnea, wheezing, FEV1/FVC or PEFR. This is the reason that I posted my last response the way I did. I personally would rather use a mouthpiece when possible becasue it promotes breathing through the mouth not the nose. It also decreases the amount of conversation had by therapist and patient. Not that conversation is wrong or bad, but during the treatment patients should be breathing drug not talking.


Light
 
Posts: 104 | Location: Springfield, MO | Registered: March 08, 2004Reply With QuoteReport This Post
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