Continuing Education Foundations

1 Clinical Free Continuing Education Foundations for Respiratory Therapists (CRCE). and Nurses (CNE). See Page 12. A Patient-focused Education Program for Respiratory Care Professionals Advisory Board Aerosol Therapy for Ventilator-Dependent Patients: Devices, Issues, Selection & Technique Richard Branson, MS, RRT, FAARC. Professor of Surgery University of Cincinnati College of Medicine Arzu Ari, PhD, RRT, PT, CPFT, FAARC. M. Cincinnati, OH. Kathleen Deakins, MS, RRT, NPS any types of aerosol devices for delivering inhaled therapeutics are available Supervisor, Pediatric Respiratory Care Rainbow Babies & Children's for treating mechanically ventilated patients.

2 Each type of device has advan- Hospital of University Hospitals Cleveland, OH tages and disadvantages, which are discussed in this article. Many variables must be William Galvin, MSEd, RRT, CPFT, AE-C, FAARC accounted for to optimize the technique of delivery and the amount of medication Program Director, Respiratory Care Program Gwynedd Mercy College, Gwynedd Valley, PA. administered. It begins with choosing the right device based on the medication to be Carl Haas, MS, RRT, FAARC. Educational & Research Coordinator administered, knowing what particle size will be produced over what period of time, University Hospitals and Health Centers Ann Arbor, MI then determining how aspects of mechanical ventilation will affect medication deliv- Richard Kallet, MSc, RRT, FAARC ery and deposition.

3 Intermittent versus continuous nebulization, the nebulizer type, Clinical Projects Manager University of California Cardiovascular Research Institute the type of spacer and its electrostatic charge, and the aerosol device's position in San Francisco, CA. the ventilator circuit all affect the efficiency of aerosol delivery. Ventilator parameters, Neil MacIntyre, MD, FAARC. Medical Director of Respiratory Services including flow rate, pressurization, and features like the presence of a heat-moisture Duke University Medical Center Durham, NC exchanger also affect medication delivery. In addition, correct patient positioning can Tim Myers, BS, RRT-NPS.

4 Pediatric Respiratory Care improve treatment efficacy and response. Rainbow Babies and Children's Hospital Cleveland, OH. Tim Op't Holt, EdD, RRT, AE-C, FAARC. Professor, Department of Respiratory Care Aerosol Therapy In Spontaneously Breathing & Mechanically and Cardiopulmonary Sciences University of Southern Alabama Ventilated Patients: Description, Selection & Issues Mobile, AL. Helen Sorenson, MA, RRT, FAARC Moderator: Tim Myers, RRT-NPS, MBA, FAARC. Assistant Professor, Dept. of Respiratory Care Panelists: Ariel Berlinski, MD. University of Texas Health Sciences Center San Antonio, TX Bruce Rubin, MD, MEngr, MBA.

5 Rajiv Dhand, MD, FCCP, FACP, FAARC. Webinars Clinical Foundations is dedi- M any issues surround the selection and use of aerosol therapy in all populations of patients. Matching the medication to the delivery device is key, as is under- standing how the mechanistic attributes of nebulizers and mechanical ventilation can cated to providing respira- tory therapists with clinically work together or against each other in delivering medication effectively. Each nebu- relevant, evidence-based lizer option offers advantages and disadvantages that need to be assessed according topics. Clinical Foundations to patient need, the medication involved, and use with mechanical ventilation (if pres- is pleased to announce a we- ent).

6 Aerosol therapy for pediatric patients poses a unique set of challenges. Standards binar series featuring leading of practice are still evolving regarding minimizing the risk ventilator-associated pneu- respiratory care profession- monia with aerosol treatments. Adherence to treatment regimens is a global issue als. To find out more about the current webinar and to that encompasses patient perceptions, patient/family Education , financial concerns, register, go to insurance reimbursement, and other factors. Our panel of experts discusses a patient- Each webi- focused approach to aerosol therapy in mechanically ventilated and spontaneous nar is accredited for CRCEs breathing patients.

7 By the AARC. 2012-1386 This program is sponsored by Teleflex Clinical Foundations Aerosol Therapy for Ventilator- Dependent Patients: Devices, Issues, Selection & Technique Arzu Ari, PhD, RRT, PT, CPFT, FAARC. A. erosol devices have been used to moves liquid formulations through a fine pMDIs: (1) chlorofluorocarbon (CFC) and administer inhaled medications mesh to generate ,2,5 The mesh neb- (2) hydrofluoroalkane (HFA). HFA-pMDIs since the invention of modern ulizer is a single-use device with a vibrating are different from CFC-pMDIs in terms of mechanical ventilators. Although aperture plate designed to deliver aerosol- the formulation, metering-valve and actua- many new aerosol devices are available for ized medications to mechanically-ventilated tor ,9 For example, HFAs contain ventilator-dependent patients, successful patients.

8 The nebulizer is compatible with ethanolic solutions while CFCs use a sur- aerosol therapy still depends on thorough conventional ventilators. Because the mesh factant for dispersion. HFAs have a softer clinician knowledge of aerosol devices and nebulizer operates without compressed gas, and finer aerosol spray with greater lung their proper use. This paper explains the it does not change ventilator parameters deposition than However, despite types of aerosol devices available on the and the reservoir of the nebulizer can be re- differences in the pMDI formulations, HFA- market and provides strategies for choos- filled without interrupting ventilation.

9 Fur- pMDIs are similar to those of CFC pMDIs, ing the right device for optimal treatment of thermore, mesh nebulizers are easy to use in terms of bronchodilator response,15,16. mechanically-ventilated patients. and have a higher rate of drug output than pulmonary function17,18 and side jet nebulizers. Unlike ultrasonic nebulizers, A variety of spacers are used for aerosol Description of Aerosol Delivery they do not affect the temperature or con- drug delivery in mechanically-ventilated pa- Devices centration of the solution being tients. However, electrostatic charge and the Nebulizers: Jet, ultrasonic and mesh As with other new nebulizers, mesh type of spacer need to be considered.

10 The nebulizers are used for aerosol drug delivery nebulizer designs are portable, handheld, electrostatic charge decreases aerosol deliv- by converting liquid medications into small and highly efficient with low residual vol- ery by drawing small particles to the walls droplets that can be inhaled into the lower ,2,5 They also have a silent operation of the chamber; therefore, clinicians need respiratory tract of ventilator-dependent and rapid output. Also, solutions, proteins to review the electrostatic properties of the patients. and liposomal formulations can be nebu- spacer before treatment.