Respiratory care
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The primary aim of the disease management program (DMP) for patients with asthma is to improve health outcomes and to reduce costs. Five years after its introduction in Germany, no consensus has yet been reached as to whether DMP has been effective in reaching these goals. ⋯ In the first 4 years of DMP there was an improvement in pharmacotherapy and patient self management. The proportion of subjects requiring hospitalization decreased. Our results suggest that the German DMP for asthma has been effective in enhancing the quality of care in regard to an improved symptom frequency, adherence to guidelines, pharmacotherapy, and hospitalization.
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Comparative Study
Albuterol delivery by 4 different nebulizers placed in 4 different positions in a pediatric ventilator in vitro model.
The type of aerosol generator and the position in the ventilator circuit are crucial to determine aerosol delivery during mechanical ventilation. We compared lung deposition of albuterol aerosols generated by 4 different nebulizers placed in-line in 4 different positions in a pediatric ventilator model. ⋯ The vibrating mesh nebulizer was the most efficient device. The nebulizers were more efficient when placed at either the ventilator or the humidifier, and less efficient when placed at either the Y-piece or 30 cm from the Y-piece. These conclusions are valid for the tested conditions. Data regarding optimization of operating conditions should not be extrapolated among nebulizers of different operating principles.
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Airway acidification plays a role in disorders of the pulmonary tract. We hypothesized that the inhalation of alkalinized glycine buffer would measurably alkalinize the airways without compromising lung function or causing adverse events. We evaluated the safety of an inhaled alkaline glycine buffer in both healthy subjects and in subjects with stable obstructive airway disease. ⋯ Alkalinization of airway lining fluid is accomplished with inhalation of alkaline glycine buffer and causes no adverse effects on pulmonary function or vital signs.
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User-friendly scores to assess knowledge of guidelines for prevention of ventilator-associated pneumonia (VAP) are scarce and have mainly evaluated nurses, but not students or physicians. Gaps between knowledge and actual clinical practice have not been sufficiently analyzed. We assessed knowledge of and adherence to guidelines for prevention of VAP among physicians, nurses, and students in adult ICUs. ⋯ A simple, easy-to-complete questionnaire enabled us to rapidly evaluate personal knowledge and reported clinical practice in prevention of VAP in large teaching institutions. These scores will be used as baseline figures to assess the impact of educational and intervention campaigns.