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Questions and Answers
What is the correct placement of an HME in a respiratory circuit?
Which particle size range is considered ideal for aerosol deposition in the airways?
Which condition is NOT an indication for the delivery of aerosol therapy?
How does particle mass affect aerosol behavior according to the principles of aerosol therapy?
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What happens to hygroscopic aerosols when they absorb water?
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What type of tonicity does NOT describe an aerosol solution?
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Which factor does NOT influence aerosol deposition in the airways?
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What is the expected effect of increasing the temperature on aerosol particles?
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In aerosol therapy, which type of delivery targets the lung parenchyma?
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Which is NOT a characteristic of aerosols relevant to aerosol therapy?
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What is a key characteristic that differentiates a holding chamber from a spacer in aerosol therapy?
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What is the minimum inspiratory flow required for the effective use of dry powder inhalers?
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Which type of nebulizer is specifically intended for the continuous administration of aerosolized medications?
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In aerosol therapy, which delivery method allows for the cooling or warming of the aerosol mist?
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What precaution should be taken when using dry powder inhalers to ensure the medication is effectively delivered?
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What is a key feature of the Respigard II Small-Volume Nebulizer?
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Which nebulizer is specifically designed to minimize medication waste by only nebulizing during inspiration?
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Which aerosol device is best suited for patients requiring an aerosol delivery that bypasses the upper airway?
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What distinguishes Hydrofluoroalkane (HFA) propellants from previous propellants used in metered dose inhalers?
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Which statement about aerosol masks is correct?
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What is the main advantage of using a holding chamber in aerosol therapy for patients with poor coordination?
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Which scenario best describes the appropriate use of a large-volume nebulizer?
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What is a critical aspect to ensure effective delivery when using dry powder inhalers?
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In the context of aerosol therapy, what differentiates a spacer from a holding chamber?
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What consideration must be made regarding inspiratory flow when using dry powder inhalers?
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What is the primary purpose of a face tent in aerosol therapy?
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Which of the following characteristics does a face tent NOT possess as an aerosol delivery device?
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In what scenario is the use of a face tent most likely indicated?
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How is a face tent secured in place during use?
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Which of the following statements about the face tent is incorrect?
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Study Notes
Heat Moisture Exchanger (HME) /
- Must be placed after the wye in a circuit, proximal to the patient
- Needs to communicate with both inhaled and exhaled gas
- Comes in various shapes, sizes, and brands
Aerosol Therapy
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Indications for Aerosol Therapy
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Delivery of bland aerosols:
- Indications include upper air way edema, bypassed upper airway, and sputum specimen/secretion mobilization
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Delivery of aerosols to the upper airway:
- Indications include upper airway inflammation, anesthesia, rhinitis, and systemic diseases (e.g., inhaled insulin)
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Delivery of aerosols to the lung parenchyma:
- Indications include the need to deliver a topical medication targeting the parenchyma or for systemic absorption.
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Delivery of bland aerosols:
Physics of Humidity and Aerosol Therapy
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Physical Characteristics of Aerosols:
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Particle size and mass:
- Radius (R), volume (V), and mass (M) all increase or decrease directly
- As mass (M) decreases, gravity (g) has less effect, and the particle remains suspended longer.
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Hygroscopic:
- Absorbs water, causing it to fall out of suspension.
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Tonicity:
- Can be hypertonic, isotonic, or hypotonic.
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Electrical charge:
- Has no physiologic effects but may affect other equipment, such as EKG.
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Particle size and mass:
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Factors Influencing Aerosol Deposition in the Airways:
- Particle size and Gravity: 1 to 5 microns is ideal for deposition in the airways.
- Inertia: Larger particles impact in the oropharynx.
- Temperature and humidity: Particles may evaporate or coalesce.
- Respiratory pattern: Slow, deep inspiration followed by a brief inspiratory pause, proper instruction enhances deposition.
Aerosol Therapy Equipment
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Metered Dose Inhalers (MDIs) are pressurized canisters dispensing propellant and medication.
- Chlorofluorocarbons (CFCs) were previously used as propellants but are no longer used due to ozone layer damage.
- Hydrofluoroalkane (HFA) is the only propellant used in current MDIs.
- Proper positioning is critical for optimal lung expansion during MDI administration.
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Holding Chambers/Spacers slow down delivery allowing the propellant to evaporate and larger particles to settle out.
- Holding Chambers have a one-way valve, while Spacers do not.
- Both are helpful for patients with poor coordination.
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Dry Powder Inhalers: Aerosol in a dry powder form requiring sufficient inspiratory flow rate (40 to 60 L/min) to inhale the medication.
- No propellant needed
- Examples include Diskhaler, Diskus, Turbuhaler, andEllipta.
- Keeping the unit level is crucial to prevent the dry powder from falling out.
Large Volume Nebulizers
- Continuous aerosol therapy
- Large-bore aerosol tubing enhances medication delivery
- Delivers a cool OR warm mist of aerosolized medications.
Small Volume Nebulizers
- Respigard II is an expiratory filtered nebulizer capable of smaller particles (< 2 microns), often used for Pentamidine (for PCP).
- Salter Labs Medical Products NebutechTM HDNTM utilizes one-way valves enhancing inspiratory delivery, delivering 80% of the medication at < 5 microns particle size.
- Monaghan Medical Corporation AeroEclipse® Breath-Actuated Nebulizer generates aerosol only during inspiration, reducing medication waste and potentially allowing for smaller doses.
Aerosol Administration Devices
- Briggs adapter or aerosol T: A T-shaped device with three ports that connects to aerosol tubing and can be used with various masks and devices.
- Aerosol Mask is similar to a simple mask with a large-bore inlet (22mm).
- Trach Mask fits over a tracheostomy tube and is secured with an elastic strap.
- Face tent is used in recovery and for facial burns, securing under the chin and enclosing the lower part of the face.
Small-Particle Aerosol Generator (SPAG)
- Specifically designed to deliver Ribavirin to treat RSV (respiratory syncytial virus).
- Delivers particles with a mean diameter of 1.3 microns.
- Requires two gas supplies for aerosol generation and drying.
- Administration via tent or hood.
- Potential toxic effects of Ribavirin include conjunctivitis, rash, bronchospasm. Caution is advised in pregnant/nursing individuals.
- Requires negative pressure room with appropriate PPE (HEPA mask, gloves, gown and goggles).
Ultrasonic Nebulizers
- Utilize high-frequency sound waves to generate an aerosol
- Components: generator, cable, piezoelectric crystal, reservoir, fan
- Frequency determines particle size (smaller particles at higher frequencies).
- Amplitude governs output.
- Hazards: shock and nosocomial infections.
Small-Volume Ultrasonic Nebulizers
- Smaller fill volume (<10mL)
- Include internal batteries, 12v and 120v adapters.
- Deliver smaller particles than conventional gas-powered nebulizers.
- More expensive compared to other options.
Vibrating Mesh Nebulizers
- Pumps fluid through a vibrating mesh to create an aerosol.
Metered Dose Inhalers (MDI)
- Pressurized canister containing propellant and drug.
- Previous propellants were Chlorofluorocarbons (CFCs) but are no longer used due to damage to the ozone layer.
- Current propellants are Hydrofluoroalkane (HFA).
- Good positioning is key to lung expansion.
MDI Administration
- Patient should be sitting up.
- Breathe out fully through mouth.
- Insert mouthpiece into mouth and seal lips around it.
- If no spacer is available, hold the MDI a few cm in front of the mouth.
- Press down on canister at the beginning of a breath and breathe in slowly and deeply.
- Perform an inspiratory hold for up to 10 seconds.
- Exhale slowly.
- Repeat as needed to achieve the desired dose.
Holding Chamber vs Spacer
- Allows the propellant to evaporate and slows the delivery of medication.
- Larger particles fall out.
- A holding chamber has a one-way valve that holds the medication for a few seconds.
- Holding chambers are good for patients with poor coordination.
- A spacer doesn't have a one-way valve, medication goes directly to the patient.
Dry Powder Inhalers (DPI)
- Contains a dry powder form of medication.
- Ambient air is drawn through a small dose.
- No propellant is needed.
- The patient must have sufficient inspiratory flow (40 to 60 L/min minimum).
- Examples include Diskhaler, Diskus, Turbuhaler, and Ellipta.
- Keep the unit level, to avoid the dry powder falling out.
Large-Volume Nebulizers
- Used to provide continuous aerosol therapy.
- Large-bore aerosol tubing maximizes delivery.
- Can deliver cool/warm mist and aerosolized medication.
HEART Nebulizer
- High Output Extended Aerosol Respiratory Therapy.
- Intended for continuous administration of aerosolized medications.
- 240 mL reservoir.
- 2.2 – 3.5 microns particle size.
Specialized SVNs
- Respigard II Small-Volume Nebulizer uses an expiratory filter and is capable of particles less than 2 microns. It is often used to administer Pentamidine (for PCP).
- Salter Labs Medical Products NebuTechTM HDNTM enhances delivery during inspiration via one-way valves; 80% of delivery is less than 5 microns.
- Monaghan Medical Corporation AeroEclipse® Breath-Actuated Nebulizer nebulizes only on inspiration, resulting in less medication waste; smaller doses may be effective.
Aerosol Administration Devices
- Briggs adapter or aerosol T.
- Aerosol mask.
- Trach mask.
- Face tent.
Brigg’s Adapter (aerosol T)
- 2 / 22mm ports opposite each other with a 15mm port at a right angle.
- Use with 6” aerosol tubing as a reservoir.
Aerosol Mask
- Similar to a simple mask, but the inlet is for large-bore (blue) tubing (22mm).
Trach Mask
- Fits over a tracheostomy tube; secured with an elastic strap; 22mm large-bore inlet.
Face Tent
- Straps under the chin, enclosing only the lower part of the face.
- Used in recovery and for facial burns.
Small-Particle Aerosol Generator (SPAG)
- Specifically designed to deliver ribavirin as a treatment for RSV.
- Mean diameter of 1.3 microns.
- Has 2 gas supplies: one for creating the aerosol and one for a drying chamber to further reduce particle diameter.
SPAG (cont’d.)
- Ribavirin is administered via a tent or hood.
- Potential drug toxic effects: conjunctivitis, rash, bronchospasm.
- Avoid exposure to pregnant or nursing women.
- Precautions: negative P room, HEPA mask, gloves, gown, goggles
Ultrasonic Nebulizers
- Utilize high-frequency sound waves (Hz, amplitude).
- Components: generator, cable, piezoelectric crystal, reservoir, fan.
- Frequency determines the particle size (1-10 microns), higher frequency means smaller particles.
- Amplitude controls the output (greater amplitude = greater output).
- Hazards: shock, nosocomial infections.
Comparison between Frequency & Amplitude
- Frequency: smaller particle size
- Amplitude: greater output
DeVilbiss Ultra Neb 99
- Is an example of an ultrasonic nebulizer.
Small-Volume Ultrasonic Nebulizers for Medication Delivery
- Ultrasonic nebs with a fill volume of less than 10mL.
- Have internal batteries, 12v & 120v adapters.
- Produce smaller particles than conventional gas-powered nebs.
- Tend to be expensive.
Vibrating Mesh Nebulizers
- Pumps push fluid through vibrating mesh to create aerosol.
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Description
This quiz explores the principles and practices of aerosol therapy, including the indications for various aerosol delivery methods and the role of heat moisture exchangers. It also covers the physical characteristics of aerosols, emphasizing particle size and mass. Test your knowledge on these essential respiratory care topics.
