Pediatric Pulmonary Medicine Division, Arkansas Children's Hospital, Little Rock, Arkansas, USA.
Respir Care. 2012 Aug;57(8):1234-41. doi: 10.4187/respcare.01518. Epub 2012 Feb 17.
Therapeutic inhaled aerosols are often delivered to spontaneously breathing tracheostomized children. Although aerosol delivery can be affected by several factors, no recommendations for device/drug formulation choice are available. We hypothesized that practice modalities will vary among different institutions.
The respiratory care departments in institutions in the United States that train pediatric pulmonologists were surveyed regarding their practices of delivering aerosols to spontaneously breathing tracheostomized children. Characteristics of the institution; use of metered-dose inhalers (MDIs), nebulizers, and dry powder inhalers; use of a resuscitation bag to aid aerosol delivery (assisted); types of medication used; and factors affecting choice of delivery method were recorded.
Of the invited institutions, 81% (38/47) participated, with 68% of them being freestanding children's hospitals. MDIs were used by 92% of the institutions surveyed, with similar use of unassisted (32%, with 83% of them using spacers), assisted (34%, with 100% of them using non-valved spacers), and both techniques (34%). Nebulizers were used by 97% of the institutions surveyed, with all using unassisted and 32% also using assisted technique. Tracheostomy aerosol mask was the most commonly used interface (89%). Assisted technique for either MDI or nebulizer was used by 68% of the institutions surveyed, with similar use of flow-inflating bag, self-inflating bag, and both devices. Types of inhaled medications utilized by surveyed institutions included aerosolized antibiotics (82%), corticosteroids (100%), short-acting β agonists (100%), combination therapy (32%), and mucolytics (84%). Dry powders were not used. Patient cooperation was the most frequent and single most important factor influencing the choice of delivery method.
A wide variation in practice of delivering aerosols to spontaneously breathing tracheostomized children was noted. In-vivo and in-vitro studies are needed to support clinical recommendations.
治疗性吸入气雾剂常被输送至自主呼吸的气管切开患儿。尽管气雾剂输送可能受多种因素影响，但尚无设备/药物制剂选择的推荐。我们假设不同机构的实践方式会有所不同。
调查美国培训儿科肺科医生的机构的呼吸护理部门，了解其向自主呼吸的气管切开患儿输送气雾剂的做法。记录机构特征；计量吸入器（MDI）、雾化器和干粉吸入器的使用情况；使用复苏气囊辅助气雾剂输送（辅助）；使用的药物类型；以及影响输送方法选择的因素。
在所邀请的机构中，81%（38/47）参与了调查，其中 68%为独立的儿童医院。92%的调查机构使用 MDI，其中 32%（83%使用了储雾罐）、辅助（34%，100%使用无阀储雾罐）和两者都用（34%）的方法相似。97%的调查机构使用雾化器，所有机构都使用无辅助方法，32%的机构也使用辅助方法。气管切开气雾剂面罩是最常用的接口（89%）。68%的调查机构使用辅助的 MDI 或雾化器技术，相似地使用了充气式袋、自膨式袋和两者都用。调查机构使用的吸入药物类型包括雾化抗生素（82%）、皮质类固醇（100%）、短效β激动剂（100%）、联合治疗（32%）和黏液溶解剂（84%）。干粉未被使用。患儿配合是影响输送方法选择的最常见和最重要的单一因素。
我们注意到，向自主呼吸的气管切开患儿输送气雾剂的实践存在广泛差异。需要进行体内和体外研究，以支持临床建议。
