Individualized aerosol medicine: Integrating device into the patient.

Pulmonary drug delivery is complex due to several challenges including disease-, patient-, and clinicians-related factors. Although many inhaled medications are available in aerosol medicine, delivering aerosolized medications to patients requires effective disease management. There is a large gap in the knowledge of clinicians who select and provide instructions for the correct use of aerosol devices. Since improper device selection, incorrect inhaler technique, and poor patient adherence to prescribed medications may result in inadequate disease control, individualized aerosol medicine is essential for effective disease management and control. The components of individualized aerosol medicine include: (1) Selecting the right device, (2) Selecting the right interface, (3) Educating the patient effectively, and (4) Increasing patient adherence to therapy. This paper reviews each of these components and provides recommendations to integrate the device and interface into the patient for better clinical outcomes.

Aerosol drug delivery to tracheotomized patients with COVID-19: Pragmatic suggestions for clinicians.

Because of the wide and rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the number of hospitalized patients with coronavirus disease 2019 (COVID-19) has rapidly increased medically complex and resource-intensive treatment requirements in health care settings. Although tracheostomy is frequently needed for critically ill patients requiring extended mechanical ventilation, it has been described as an aerosol-generating procedure that puts health care professionals at an increased risk of viral transmission. In addition, the delivery of aerosolized medications to this patient population has become controversial because of concerns on the transmission of SARS-CoV-2 via droplets. Although aerosol therapy in spontaneously breathing patients with COVID-19 was described in recent publications, innovations in aerosol drug delivery to COVID-19 patients with tracheostomy have not been presented. Therefore, empirically based guidance on how to deliver aerosols safely and effectively to tracheotomized patients with COVID-19 is still lacking. This paper provides recommendations and rationales for device selection, interface selection, delivery techniques, and infection control based on the evolving body of literature.

How to deliver aerosolized medications through high flow nasal cannula safely and effectively in the era of COVID-19 and beyond: A narrative review.

BACKGROUND: The treatments of COVID-19 involve some degree of uncertainty. Current evidence also shows mixed findings with regards to bioaerosol dispersion and airborne transmission of COVID-19 during high flow nasal cannula (HFNC) therapy. While coping with this global pandemic created hot debates on the use of HFNC, it is important to bring detached opinions and current evidence to the attention of health care professionals (HCPs) who may need to use HFNC in patients with COVID-19. AIM: The purpose of this paper is to provide a framework on the selection, placement, and use of nebulizers as well as HFNC prongs, gas flow, and delivery technique via HFNC to help clinicians deliver aerosolized medications through HFNC safely and effectively in the era of COVID-19 and beyond. METHODS: We searched PubMed, Medline, CINAHL, and Science Direct to identify studies on aerosol drug delivery through HFNC using the following keywords: ("aerosols," OR "nebulizers") AND ("high flow nasal cannula" OR "high flow oxygen therapy" OR "HFNC") AND ("COVID-19," OR "SARS-CoV-2"). Twenty-eight articles including in vitro studies, randomized clinical trials, scintigraphy studies, review articles, prospective and retrospective research were included in this review. DISCUSSION AND RESULTS: It is not clear if the findings of the previous studies on bacterial contamination could be applied to viral transmission because they do not provide data that could be extrapolated to the risk of SARS-CoV-2 transmission. In the face of the unknown risk with the transmission of COVID-19 during HFNC therapy, the benefits of HFNC must be weighed against the risk of infection to HCPs and other patients. Due to the limited number of ventilators available in hospitals and the confirmed effectiveness of HFNC in treating hypoxemic respiratory failure, HFNC may prevent early intubation, and prolonged intensive care unit stays in patients with COVID-19. CONCLUSION: Clinicians should review the magnitude of this risk based on current evidence and use the suggested strategies of this paper for safe and effective delivery of aerosolized medications through HFNC in the era of COVID-19 and beyond.

Students' perceived self-efficacy, expectations, barriers, and support in enrolling in a master's degree program in respiratory care.

BACKGROUND: Respiratory care programs are under pressure to recruit and retain students in both undergraduate and graduate programs. Factors that influence undergraduate students' decisions to continue their education into an advanced degree program are not fully understood. The purpose of this study is to determine students' perceived self-efficacy, outcome expectations, barriers, and support to attend a Master of Science in Respiratory Care (MSRC) program. METHODS: This study used a survey from a previous study that included questions on undergraduate student self-efficacy, outcome expectations, perceived barriers and was utilized to assess students' perceptions of the support to attend an MSRC and its impact on their career goals. Student self-efficacy is defined as a person's beliefs and ability about his/her capacity to succeed in a specific situation. All undergraduate students (n = 89) in the Bachelor of Science in Respiratory Care program at Texas State University were invited to participate in the study. RESULTS: A total of 87 surveys were collected (42 juniors and 45 seniors) with a response rate of 97.7%. Ninety percent of study participants were female, and the average age was 22.54 ± 3.50 years. Self-efficacy results indicate that 88.5% of our undergraduate students believe they would be successful if enrolled in the MSRC program. Only 58.6% are interested in pursuing the MSRC, possibly because 51.7% do not think the MSRC is required for the job they want. However, 98.8% believe the MSRC will create more opportunities for them. Cost (34%), tired of schoolwork (20%), and marriage (10%) are the three main reasons not to attend the MSRC. Of those interested in an MSRC program, 71.3% reported that they do not know if they can receive financial support for graduate studies, 71% are unaware of how to contact a graduate program coordinator, and 89% fear difficulty in navigating graduate school and networking with others. CONCLUSION: Respiratory care students have self-efficacy to attend an MSRC program and believe it will provide more opportunities for them. However, cost and resource awareness are the main barriers to enrolling in the graduate program. This study highlights students' perceived barriers and challenges in advancing their knowledge and continuing their education with an MSRC degree and the need for student support.

High-frequency oscillatory ventilation: A narrative review.

High-frequency oscillatory ventilation (HFOV) is a lung-protective strategy that can be utilized in the full spectrum of patient populations ranging from neonatal to adults with acute lung injury. HFOV is often utilized as a rescue strategy when conventional mechanical ventilation (CV) has failed. HFOV uses low tidal volumes and constant mean airway pressures in conjunction with high respiratory rates to provide beneficial effects on oxygenation and ventilation, while eliminating the traumatic "inflate-deflate" cycle imposed by CV. Although statistical evidence supporting HFOV is particularly low, potential benefits for its application in many clinical manifestations still remain. High-frequency oscillation is a safe and effective rescue mode of ventilation for the treatment of acute respiratory distress syndrome (ARDS). All patients who have ventilator-induced lung injury (VILI) or are at risk of developing VILI or ARDS would be suitable candidates for HFOV, especially those who have failed conventional mechanical ventilation. This narrative aims to provide a review of HFOV vis-à-vis its indications, contraindications, hazards, parameters to monitoring, patient selection, clinical goals, mechanisms of action, controls for optimizing ventilation and oxygenation, clinical application in ARDS, and a comparison with other modes of mechanical ventilation.

Filling the gaps in the evaluation and selection of mobile health technologies in respiratory medicine.

INTRODUCTION: Mobile health (mHealth) technology in respiratory medicine is a fast-growing and promising digital technology that is popular among patients and healthcare providers (HCPs). They provide reminders and step-by-step instructions for the correct inhalation technique, monitor patients' adherence to treatment, and facilitate communication between patients and HCPs. AREAS COVERED: While numerous mHealth apps have been developed over the years, most applications do not have supporting evidence. Selecting the best mHealth app in respiratory medicine is challenging due to limited studies carrying out mHealth app selection. Although mHealth technologies play an important part in the future of respiratory medicine, there is no single guide on the evaluation and selection of mHealth technologies for patients with pulmonary diseases. This paper aims to provide an overview of mHealth technologies, particularly emphasizing digital inhalers and standalone applications used in asthma. Additionally, it offers insights into the evaluation, selection, and pertinent considerations surrounding mHealth applications in respiratory medicine. EXPERT OPINION: Evaluating mHealth apps will take time, resources, and collaboration between stakeholders such as governmental regulatory bodies, subject-matter experts, and industry representatives. Filling the gaps in the evaluation and selection of the mHealth app will improve clinical decision-making, personalized treatments, self-management and disease monitoring in respiratory medicine.

Impact of Program Components on Perceived Organizational Support in Respiratory Care Education.

BACKGROUND: Perceived organizational support has been linked to employee commitment and job satisfaction. Understanding the effects of perceived organizational support on employees allows leaders to improve employees' performance and the success of their organizations. The purpose of this study was to identify the perceived organizational support across different respiratory care education programs in the United States. METHODS: All chairs and program directors of bachelor's of science and master's of science degree respiratory care education programs in the United States were surveyed (N = 97). The Survey of Perceived Organizational Support was modified after written approval, and the final instrument included 31 items with a Likert scale (1 = strongly disagree, 7 = strongly agree). Descriptive statistics, multiple regression, and topic modeling were used for data analysis (P < .05). RESULTS: A total of 67 respondents responded to the perceived organizational support survey; a 69% response rate. They were satisfied with their job and committed to their institutions. They also reported that faculty salaries were equitable relative to the national average, and their institutions encouraged teamwork among faculty. The respondents' titles, total years of administrative experience, students' scores on the national credentialing therapist multiple choice examination (TMC), and institutions that offer both bachelor's of science and master's of science degree programs had a direct relationship with perceived organizational support in respiratory care education programs. Age and sex were inversely related to perceived organizational support. A topic modeling analysis based on the respondents' opinions about perceived organizational support showed that the respondents frequently mentioned the words support, institution, budget, year, nursing, and experience. The respondents emphasized the importance of support, institution marketing, their years of experience, and the program budget. They also mentioned that nursing programs overshadowed respiratory care education programs at their institutions. CONCLUSIONS: Age, sex, job title, years of administrative experience, students' TMC scores, and the type of programs offered impacted perceived organizational support by respiratory care directors. Student-, program- and participant-related factors can be used to improve perceived organizational support in respiratory care education.

A Systematic Review of Artificial Intelligence Used to Predict Loneliness, Social Isolation, and Drug Use During the COVID-19 Pandemic.

This systematic literature review evaluates the role of machine learning, artificial intelligence (AI), and social determinants of health (SDOH) in identifying loneliness during the COVID-19 pandemic. By examining various studies and articles through a comprehensive search of databases EBSCOhost, Medline Complete, Academic Search Complete, Directory of Open Access Journals, and Complementary Index, the research team sought to discern consistent themes and patterns. We identified four constructs central to understanding the impact of the pandemic on societal well-being: (1) the prediction of compliance with COVID-19 measures, (2) the prediction of loneliness and its effects, (3) the prediction of well-being and social inclusion, and (4) the prediction of drug use. Within these constructs, prevalent themes related to opioid overdose, stress levels, mental health, well-being, and cognitive decline emerged. The adherence to the PRISMA 2020 checklist has resulted in a PRISMA flow diagram that categorizes the selected literature. The findings of this review, including the proportion of studies predicting various attributes related to loneliness, demonstrate the critical intersections between machine learning, AI, SDOH, and the psychosocial phenomenon of loneliness amidst a global health crisis. The review results provide a summary of the occurrences and predictive percentages of each construct as determined by the literature, contributing to a nuanced understanding of the pandemic's multifaceted impact on loneliness, social isolation, and drug use. Using AI to predict these constructs has remarkable capabilities in identifying individuals at risk and facilitating timely interventions to mitigate adverse outcomes and promote mental health resilience in the face of challenges such as the COVID-19 pandemic. Moving forward, future research is warranted to refine AI algorithms, validate predictive models and utilize AI-based interventions in healthcare and mental health services while ensuring data security, and individuals' privacy.

Dos and don'ts to optimize transnasal aerosol drug delivery in clinical practice.

INTRODUCTION: Transnasal aerosol drug delivery has become widely accepted for treating acutely ill infants, children, and adults. More recently aerosol administration to wider populations receiving high and low-flow nasal oxygen has become common practice. AREAS COVERED: Skepticism of insufficient aerosol delivery to the lungs has been tempered by multiple in vitro explorations of variables to optimize delivery efficiency. Additionally, clinical studies demonstrated comparable clinical responses to orally inhaled aerosols. This paper provides essential clinical guidance on how to improve transnasal aerosol delivery based on device-, settings-, and drug-related optimization to serve as a resource for educational initiatives and quality enhancement endeavors at healthcare institutions. EXPERT OPINION: Transnasal aerosol delivery is proliferating worldwide, but indiscriminate use of excessive-high flows, poor selection and placement of aerosol devices and circuits can greatly reduce aerosol delivery and efficacy, potentially compromising treatment to acute and critically ill patients. Attention to these details can improve inhaled dose by an order of magnitude, making the difference between effective treatment and the progression to more invasive ventilatory support, with greater inherent risk and cost. These revelations have prompted specific recommendations for optimal delivery, driving advancements in aerosol generators, formulations, and future device designs to administer aerosols and maximize treatment effectiveness.

Guidance on Mitigating the Risk of Transmitting Respiratory Infections During Nebulization by the COPD Foundation Nebulizer Consortium.

BACKGROUND: Nebulizers are used commonly for inhaled drug delivery. Because they deliver medication through aerosol generation, clarification is needed on what constitutes safe aerosol delivery in infectious respiratory disease settings. The COVID-19 pandemic highlighted the importance of understanding the safety and potential risks of aerosol-generating procedures. However, evidence supporting the increased risk of disease transmission with nebulized treatments is inconclusive, and inconsistent guidelines and differing opinions have left uncertainty regarding their use. Many clinicians opt for alternative devices, but this practice could impact outcomes negatively, especially for patients who may not derive full treatment benefit from handheld inhalers. Therefore, it is prudent to develop strategies that can be used during nebulized treatment to minimize the emission of fugitive aerosols, these comprising bioaerosols exhaled by infected individuals and medical aerosols generated by the device that also may be contaminated. This is particularly relevant for patient care in the context of a highly transmissible virus. RESEARCH QUESTION: How can potential risks of infections during nebulization be mitigated? STUDY DESIGN AND METHODS: The COPD Foundation Nebulizer Consortium (CNC) was formed in 2020 to address uncertainties surrounding administration of nebulized medication. The CNC is an international, multidisciplinary collaboration of patient advocates, pulmonary physicians, critical care physicians, respiratory therapists, clinical scientists, and pharmacists from research centers, medical centers, professional societies, industry, and government agencies. The CNC developed this expert guidance to inform the safe use of nebulized therapies for patients and providers and to answer key questions surrounding medication delivery with nebulizers during pandemics or when exposure to common respiratory pathogens is anticipated. RESULTS: CNC members reviewed literature and guidelines regarding nebulization and developed two sets of guidance statements: one for the health care setting and one for the home environment. INTERPRETATION: Future studies need to explore the risk of disease transmission with fugitive aerosols associated with different nebulizer types in real patient care situations and to evaluate the effectiveness of mitigation strategies.

Evaluating dry powder inhalers: From in vitro studies to mobile health technologies.

Dry powder inhalers (DPIs) are essential in treating patients with pulmonary diseases. Since DPIs were introduced in the 1960s, a remarkable improvement has been made in their technology, dose delivery, efficiency, reproducibility, stability, and performance based on safety and efficacy. While there are many DPIs on the market and several more under development, it is vital to evaluate the performance of DPIs for effective aerosol drug delivery to patients with respiratory disorders. Their performance evaluation includes the physicochemical properties of the drug powder formulation, metering system, device design, dose preparation, inhalation technique, and patient-device integration. The purpose of this paper is to review current literature evaluating DPIs through in vitro studies, computational fluid models, and in vivo/clinical studies. We will also explain how mobile health applications are used to monitor and evaluate patients' adherence to prescribed medications.

Aerosol delivery device selection for spontaneously breathing patients: 2012.

Using an electronic literature search for published articles indexed in PubMed between January 1990 and August 2011, the update of this clinical practice guideline is the result of reviewing 84 clinical trials, 54 reviews, 25 in vitro studies, and 7 evidence-based guidelines. The recommendations below are made following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria: 1: It is recommended that selection of the appropriate aerosol generator and interface be made based on the patient's age, physical and cognitive ability, cost, and the availability of the prescribed drug for use with a specific device. 2: Nebulizers and pressurized metered-dose inhalers (pMDIs) with valved holding chambers are suggested for use with children ≤ 4 years of age and adults who cannot coordinate the use of pMDI or dry-powder inhaler (DPI). 3: It is suggested that administration of aerosols with DPIs be restricted to patients ≥ 4 years of age who can demonstrate sufficient flow for the specific inhaler. 4: For patients who cannot correctly use a mouthpiece, aerosol masks are suggested as the interface of choice. 5: It is suggested that blow-by not be used for aerosol administration. 6: It is suggested that aerosol therapy be administered with a relaxed and nondistressed breathing pattern. 7: Unit dose medications are suggested to reduce the risk of infection. 8: It is suggested that nebulizer/drug combinations should be used as approved by the FDA. 9: It is recommended that healthcare providers know the correct use of aerosol generators; they should teach and periodically re-teach patients about how to use aerosol devices correctly. 10: It is suggested that intermittent positive-pressure breathing should not be used for aerosol therapy. 11: It is recommended that either nebulizer or pMDI can be used for aerosol delivery during noninvasive ventilation.

An in vitro evaluation of aerosol delivery through tracheostomy and endotracheal tubes using different interfaces.

BACKGROUND: Previous research reporting factors influencing aerosol delivery in intubated patients has been largely focused on the endotracheal tube (ETT) during mechanical ventilation, with little comparative analysis of effect of types of artificial airways and their interfaces on aerosol delivery during spontaneous breathing. The purpose of this study was to compare aerosol delivery via tracheostomy tube (TT) and ETT, using interfaces such as T-piece, tracheostomy collar, and manual resuscitation bag. METHODS: A teaching manikin was intubated with either an ETT (8.0 mm inner diameter) and TT (8 mm inner diameter). Both bronchi were connected to a collecting filter, attached to a sinusoidal pump simulating the breathing pattern of a spontaneously breathing adult (tidal volume 450 mL, respiratory rate 20 breaths/min, inspiratory-expiratory ratio 1:2). Albuterol sulfate (2.5 mg/3 mL) was nebulized through a jet nebulizer, using each airway and interface as appropriate (n = 3). Drug on the filter was eluted and analyzed with spectrophotometry, and expressed as mean percent of loaded dose delivered. Descriptive statistics, the Student t test, and one-way analysis of variance were applied. RESULTS: A greater percentage of nominal dose was delivered via TT than ETT with both T-piece (13.79 ± 2.59% vs 9.05 ± 0.70%) and manual resuscitation bag (45.75 ± 1.8% vs 27.23 ± 8.98%, P = .038 and P = .025, respectively). Use of manual resuscitation bag with both TT and ETT increased lung dose more than 3-fold. Inhaled dose with tracheostomy collar was (6.92 ± 0.81%) less than T-piece with TT (P = .01). CONCLUSION: In this adult model of spontaneous ventilation, aerosol therapy through ETT was less efficient than TT, while the manual resuscitation bag was more efficient than T-piece or tracheostomy collar.

Effects of the COVID-19 Pandemic on Respiratory Care Student Enrollment, Retention, and Success on the National Board for Respiratory Care Credentialing Examinations.

BACKGROUND: The purpose of this study was to ascertain whether the COVID-19 pandemic and the instructional changes implemented in response to it affected student enrollment, retention, or success on the National Board for Respiratory Care credentialing examinations at an associate degree respiratory care program in the state of Texas. METHODS: A retrospective analysis of student enrollment, retention data, and graduate success rates on the National Board for Respiratory Care credentialing examinations were used in this study. The data were collected from an associate degree respiratory care program in Texas and included 69 graduates for the 5-year study period. The 3 academic years that led up to the COVID-19 pandemic served as a "pre-pandemic" baseline for comparison. The cohort of 2019-2020 was labeled "early pandemic," the cohort of 2020-2021 was labeled "mid pandemic," and the cohort of 2021-2022 was labeled "late pandemic" for data comparison purposes. Descriptive statistics, the Kruskal-Wallis test, and the Mann-Whitney U test were used for data analysis (P < .05). RESULTS: The number of program applicants significantly decreased between the pre- and late-pandemic groups (P = .001), but overall student enrollment (P = .42) and retention (P = .95) were not significantly affected by the COVID-19 pandemic. The first-time pass rate on the Therapist Multiple-Choice examination low-cut score (P = .005) and high-cut score (P = .007) were significantly reduced in the mid-pandemic group when compared with the previous cohorts. There were no statistically significant differences in the demographic data or online questionnaire responses from the early- and mid-pandemic groups. CONCLUSIONS: The COVID-19 pandemic and the instructional changes implemented in response to it decreased students' first-time pass rate on the Therapist Multiple-Choice examination in the mid-pandemic group compared with the pre- and early-pandemic groups.

Does Valved Holding Chamber Improve Aerosol Lung Deposition with a Jet Nebulizer? A Randomized Crossover Study.

Using valved holding chambers (VHC) during aerosol therapy has been reported to improve the inhaled dose with various aerosol devices, including vibrating mesh nebulizers. The aim of this study was to quantify the pulmonary deposition of a jet nebulizer (JN) with and without a VHC, and a mesh nebulizer (MN) with a VHC in a randomized cross-over trial with seven healthy consenting adults. Our hypothesis was that the use of a VHC would improve deposition with the JN. Diethylnitriaminopentacetic acid with technetium (DTPA-Tc99m), with the activity of 1 mC with 0.9% saline solution was nebulized. The radiolabeled aerosol was detected by 2D planar scintigraphy after administration. The pulmonary deposition was greater with a JN with a VHC (4.5%) than a JN alone (3.2%; p = 0.005. However, an MN with a VHC (30.0%) was six-fold greater than a JN or JN with a VHC (p < 0.001). The extrapulmonary deposition was higher in the JN group without a VHC than in the other two modalities (p < 0.001). Deposition in the device was greater with a JN + VHC than an MN+/VHC (p < 0.001). Lower residual drug at the end of the dose was detected with an MN than either JN configuration. The exhaled dose was greater with a JN alone than either an MN or JN with VHC (p < 0.001). In conclusion, the addition of the VHC did not substantially improve the efficiency of aerosol lung deposition over a JN alone.

A path to successful patient outcomes through aerosol drug delivery to children: a narrative review.

Although using aerosolized medications is a mainstay of treatment in children with asthma and other respiratory diseases, there are many issues in terms of device and interface selection, delivery technique and dosing, as well as patient and parental education that have not changed for half a century. Also, due to many aerosol devices and interfaces available on the market and the broad range of patient characteristics and requirements, providing effective aerosol therapy to children becomes a challenge. While aerosol delivery devices are equally effective, if they are age-appropriate and used correctly, the majority of aerosol devices require multiple steps to be used efficiently. Unfortunately, many children with pulmonary diseases have problems with the correct delivery technique and do not gain therapeutic benefits from therapy that result in poor disease management and increased healthcare costs. Therefore, the purpose of this paper is to review the current knowledge on aerosol delivery devices used in children and guide clinicians on the optimum device- and interface-selection, delivery technique, and dosing in this patient population. Strategies on how to deliver aerosolized medications in crying and distressed children and how to educate parents on aerosol therapy and promote patient adherence to prescribed medications are also provided. Future directions of aerosol therapy in children should focus on these issues and implement policies and clinical practices that highlight the potential solutions to these problems.

Quantifying Delivered Dose with Jet and Mesh Nebulizers during Spontaneous Breathing, Noninvasive Ventilation, and Mechanical Ventilation in a Simulated Pediatric Lung Model with Exhaled Humidity.

Acutely ill children may transition between spontaneous breathing (SB), noninvasive ventilation (NIV), and mechanical ventilation (MV), and commonly receive the same drug dosage with each type of ventilatory support and interface. This study aims to determine the aerosol deposition with jet (JN) and mesh nebulizers (MN) during SB, NIV, and MV using a pediatric lung model. Drug delivery with JN (Mistymax10) and MN (Aerogen Solo) was compared during SB, NIV, and MV using three different lung models set to simulate the same breathing parameters (Vt 250 mL, RR 20 bpm, I:E ratio 1:3). A heated humidifier was placed between the filter and test lung to simulate exhaled humidity (35 ± 2 °C, 100% RH) with all lung models. Albuterol sulfate (2.5 mg/3 mL) was delivered, and the drug deposited on an absolute filter was eluted and analyzed with spectrophotometry. Aerosol delivery with JN was not significantly different during MV, NIV, and SB (p = 0.075), while inhaled dose obtained with MN during MV was greater than NIV and SB (p = 0.001). The delivery efficiency of MN was up to 3-fold more than JN during MV (p = 0.008), NIV (p = 0.005), and SB (p = 0.009). Delivered dose with JN was similar during MV, NIV, and SB, although the delivery efficiency of MN differs with different modes of ventilation.

Effect of Student Demographics, Prior Military Service, and Class Start Times on Academic Performance in a Respiratory Care Program.

BACKGROUND: Current research regarding the effect of demographics and characteristics of respiratory therapy students on academic performance in respiratory therapy programs is lacking. Students pursuing higher education degrees have a variety of backgrounds, and understanding the factors that impact student academic performance may improve student learning and academic outcomes. The purpose of this study was to determine the effect of age, gender, prior military service, and class start time on student academic performance in respiratory care. METHODS: A retrospective comparative study was performed with 33 students from 8 cohorts enrolled in the Respiratory Therapy Program at Concorde Career College - San Antonio between 2016-2020. The students' academic performance was assessed in the Introduction to and Application of Respiratory Therapeutics (RT 210) course; the final respiratory care course, Advanced Clinical Practice (RT 250); the secure National Board of Respiratory Care Self-Assessment Examination (NBRC SAE); and the NBRC Therapist Multiple-Choice (NBRC TMC) Examination. Independent t tests and Pearson correlations were used for data analysis. A significance level of 0.05 was considered statistically significant. RESULTS: There was no statistically significant difference between male and female students in RT 210 (P = .23), RT 250 (P = .60), the secure NBRC SAE (P = .23), and percentage of students passing the NBRC TMC (P = .96). No significant difference was found between AM and PM classes on students' academic performance in RT 210 (P = .76), RT 250 (P = .51), the secure NBRC SAE (P = .23), and percentage of students passing the NBRC TMC (P = .38). The results of this study showed no significant difference in the veteran and non-veteran student groups in RT 210 (P = .07), RT 250 (P = .69), and the secure NBRC SAE (P = .15). A strong positive correlation was discovered between academic performance in RT 210 and RT 250 courses (r = 0.725, P < .001) and between RT 210, the secure NBRC SAE (r = 0.744, P < .001), and between RT 250 and the secure NBRC SAE (r = 0.789, P < .001). The percentage of students passing the NBRC TMC was not significantly different between groups of gender (P = .64), class start times (P = .38), and prior military services (P = .96). CONCLUSIONS: Age, gender, class start times, and prior military service had no statistically significant effect on academic performance in this study. There is a positive correlation between students' performance in RT 210 and RT 250 and students' grades in these courses and the secure NBRC SAE.

Delivered dose with jet and mesh nebulisers during spontaneous breathing, noninvasive ventilation and mechanical ventilation using adult lung models.

What is the delivered dose with jet and mesh nebulisers during spontaneous breathing (SB), noninvasive ventilation (NIV), and mechanical ventilation (MV) using an adult lung model with exhaled humidity (EH)? The delivery of salbutamol sulfate (2.5 mg per 3 mL) with jet (Mistymax10) and mesh nebulisers (Aerogen Solo) was compared during SB, NIV, and MV using breathing parameters (tidal volume 450 mL, respiratory rate 20 breaths per min, inspiratory:expiratory ratio 1:3) with three lung models simulating exhaled humidity. A manikin was attached to a sinusoidal pump via a filter at the bronchi to simulate an adult with SB. A ventilator (V60) was attached via a facemask to a manikin with a filter at the bronchi connected to a test lung to simulate an adult receiving NIV. A ventilator-dependent adult was simulated through a ventilator (Servo-i) operated with a heated humidifier (Fisher & Paykel) attached to an endotracheal tube (ETT) with a heated-wire circuit. The ETT was inserted into a filter (Respirgard II). A heated humidifier was placed between the filter and test lung to simulate exhaled humidity (35±2°C, 100% relative humidity). Nebulisers were placed at the Y-piece of the inspiratory limb during MV and positioned between the facemask and the leak-port during NIV. A mouthpiece was used during SB. The delivered dose was collected in an absolute filter that was attached to the bronchi of the mannequin during each aerosol treatment and measured with spectrophotometry. Drug delivery during MV was significantly greater than during NIV and SB with a mesh nebuliser (p=0.0001) but not with a jet nebuliser (p=0.384). Delivery efficiency of the mesh nebuliser was greater than the jet nebuliser during MV (p=0.0001), NIV (p=0.0001), and SB (p=0.0001). Aerosol deposition obtained with a mesh nebuliser was greater and differed between MV, NIV, and SB, while deposition was low with a jet nebuliser and similar between the modes of ventilation tested.

Treating COPD Patients with Inhaled Medications in the Era of COVID-19 and Beyond: Options and Rationales for Patients at Home.

COVID-19 has affected millions of patients, caregivers, and clinicians around the world. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads via droplets and close contact from person to person, and there has been an increased concern regarding aerosol drug delivery due to the potential aerosolizing of viral particles. To date, little focus has been given to aerosol drug delivery to patients with COVID-19 treated at home to minimize their hospital utilization. Since most hospitals were stressed with multiple admissions and experienced restricted healthcare resources in the era of COVID-19 pandemic, treating patients with COPD at home became essential to minimize their hospital utilization. However, guidance on how to deliver aerosolized medications safely and effectively to this patient population treated at home is still lacking. In this paper, we provide some strategies and rationales for device and interface selection, delivery technique, and infection control for patients with COPD who are being treated at home in the era of COVID-19 and beyond.