RESUMEN
Congenital TEFs without esophageal atresia are rare but may occur more frequently than previously documented in literature. Careful history is required to suspect the diagnoses, as most patients will present with coughing associated with solid or liquids, recurrent unexplained pulmonary infections and complaints with eating. Some patients may show signs of chronic airway changes from recurrent aspiration pneumonia at the time of presentation. Diagnosis is challenging, with multiple imaging modalities including x ray, CT scan and esophogram able to identify a fistula. Surgery is required to improve quality of life and prevent chronic airway changes, and most cases repaired have no complications.
Asunto(s)
Fístula Traqueoesofágica/diagnóstico por imagen , Adolescente , Tos/complicaciones , Fibrosis Quística , Atresia Esofágica , Humanos , Masculino , Neumonía por Aspiración , Calidad de Vida , Radiografía , Tomografía Computarizada por Rayos X/métodosRESUMEN
BACKGROUND: Pediatric patients treated with noninvasive ventilation (NIV) are frequently given aerosol therapy. Limited pediatric data are available on the efficiency of aerosol delivery efficiency. We evaluated the effect of different nebulizers, positions in the single-limb ventilator circuit, and ventilator settings on the efficiency of aerosol delivery in a model of pediatric NIV. We hypothesized that using a vibrating mesh nebulizer, placing the nebulizer after the circuit leak, and not using the highest inspiratory positive airway pressure would increase aerosol delivery efficiency. METHODS: We connected a breathing simulator in series to a low-dead-space filter holder (lung dose) and to an anatomically correct face/airway model of a 5-y-old child. A mask with an entrainment elbow was connected to a ventilator operated in a NIV bi-level mode and assembled with a single-limb heated-wired circuit. Inspiratory/expiratory pressures of either 15/5 or 20/5 cm H2O were used. We studied 3 different jet nebulizers and 2 vibrating mesh nebulizers loaded with albuterol solution (2.5 mg/3 mL). Albuterol was measured with spectrophotometry. The outcome measure was the efficiency of aerosol delivery (ie, lung dose expressed as percentage of the nominal dose). RESULTS: Vibrating mesh nebulizers placed after the exhalation port of the circuit had the highest delivery efficiency, even compared with a vibrating mesh nebulizer integrated into the mask. Placing the nebulizer after the exhalation port of the circuit increased efficiency for all nebulizers. Vibrating mesh nebulizers were more efficient than jet nebulizers, regardless of their position in the circuit. Increasing the inspiratory pressure resulted in a variable effect on aerosol-delivery efficiency. CONCLUSIONS: In a model of pediatric NIV using a single-limb circuit, aerosol delivery devices were more efficient when placed after the exhalation port of the ventilator circuit. Vibrating mesh nebulizers were more efficient than jet nebulizers.
Asunto(s)
Albuterol , Sistemas de Liberación de Medicamentos , Terapia Respiratoria , Albuterol/administración & dosificación , Albuterol/efectos adversos , Albuterol/análisis , Broncodilatadores/administración & dosificación , Broncodilatadores/efectos adversos , Broncodilatadores/análisis , Preescolar , Sistemas de Liberación de Medicamentos/instrumentación , Sistemas de Liberación de Medicamentos/métodos , Humanos , Monitoreo Fisiológico/métodos , Nebulizadores y Vaporizadores/normas , Ventilación no Invasiva/métodos , Evaluación de Procesos y Resultados en Atención de Salud , Proyectos de Investigación , Terapia Respiratoria/instrumentación , Terapia Respiratoria/métodos , Espectrofotometría/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Noninvasive ventilation (NIV) is used to treat respiratory failure in patients with concomitant need for aerosol delivery. Limited pediatric data are available on aerosol delivery efficiency, and none at all regarding aerosol delivery efficiency with a double-limb circuit. We compared the effect of position in the double-limb ventilator circuit, types of nebulizer, and ventilator settings on aerosol delivery efficiency in a pediatric model of NIV. We hypothesized that placing a vibrating mesh nebulizer at the ventilator and using the highest inspiratory pressures would increase aerosol delivery efficiency. METHODS: A breathing simulator was connected in series to a low dead-space filter holder (lung dose) and to an anatomically correct head/airway model of a 5-year-old child. A non-vented mask connected the model to a ventilator operated on noninvasive bi-level mode and assembled with a double-limb, heated-wired adult circuit. Inspiratory pressures of either 15 or 20 cm H2O and an expiratory pressure of 5 cm H2O were used. Two different vibrating mesh nebulizers and 2 different jet nebulizers loaded with albuterol solution were studied. Albuterol was measured with spectrophotometry. Aerosol delivery efficiency was calculated as lung dose expressed as a percentage of the nominal dose. RESULTS: A vibrating mesh nebulizer before the mask or Y-piece provided the highest delivery efficiency and outperformed a vibrating mesh nebulizer integrated into the mask. Vibrating mesh nebulizers delivered more drug than jet nebulizers, regardless of their position in the circuit. Increasing the inspiratory pressure only improved aerosol delivery efficiency with a jet nebulizer placed at the ventilator. CONCLUSIONS: In a pediatric model of NIV, the effect of nebulizer position on aerosol delivery efficiency depends on the type of device and its placement in the ventilator circuit. A vibrating mesh nebulizer placed at the mask or before the Y-piece of the double-limb circuit provided the highest aerosol drug delivery during NIV. Data generated with invasive ventilation models should not be generalized to NIV models.