Effect that an educational program for cystic fibrosis patients and caregivers has on the contamination of home nebulizers

OBJECTIVE:

To describe the pathogens found in home nebulizers and in respiratory samples of cystic fibrosis (CF) patients, and to evaluate the effect that a standardized instruction regarding cleaning and disinfection of nebulizers has on the frequency of nebulizer contamination.

METHODS:

We included 40 CF patients (22 males), all of whom used the same model of nebulizer. The median patient age was 11.2 ± 3.74 years. We collected samples from the nebulizer mouthpiece and cup, using a sterile swab moistened with sterile saline. Respiratory samples were collected by asking patients to expectorate into a sterile container or with oropharyngeal swabs after cough stimulation. Cultures were performed on selective media, and bacteria were identified by classical biochemical tests. Patients received oral and written instructions regarding the cleaning and disinfection of nebulizers. All determinations were repeated an average of two months later.

RESULTS:

Contamination of the nebulizer (any part) was detected in 23 cases (57.5%). The nebulizer mouthpiece and cup were found to be contaminated in 16 (40.0%) and 19 (47.5%), respectively. After the standardized instruction had been given, there was a significant decrease in the proportion of contaminated nebulizers (43.5%).

CONCLUSIONS:

In our sample of CF patients, nebulizer contamination was common, indicating the need for improvement in patient practices regarding the cleaning and disinfection of their nebulizers. A one-time educational intervention could have a significant positive impact.     

Omissions and errors during oxygen therapy of hospitalized patients in a large city of Greece

Omissions and errors are commonly found concerning hospital oxygen use and the use of nebulizers. The aim of the study was to record oxygen use in seven hospitals located in a large district city of Greece. Another aim was to record the use of nebulizers in the same hospitals. We included 105 head nurses (HNs) working in seven hospitals of a large city district of Greece. Data were collected after interviewing each HN using a questionnaire and completing an anonymous data form. Data are expressed as percentages and analyzed using the chi-square test. We found that 41% of HN believed O(2) is a gas that improves patient's dyspnea. The majority of the nurses (88.6%) stated that there was no protocol for O(2) therapy in the departments in which they worked. We found that O(2) therapy was commonly started, modified, discontinued by nurses in the absence of a medical order. Oxygen therapy was commonly not guided by arterial blood gas (ABG) analysis. We also found that there are no guidelines to prevent O(2) therapy interruption during intra-hospital transportation, and that few measures were taken to prevent O(2) explosion. In 95.2% of the departments the nebulizers were filled with tap water and were not changed on a daily basis (81.2%). Our results indicate that educational programmes, nursing protocols and guidelines are becoming mandatory in our country in order to ensure the proper use of O(2) therapy and nebulizers.     

不同载体气体对Ohmeda Tec6地氟醚蒸发器输出浓度的影响

目的 观察不同载体气体对Ohmeda Tec6地氟醚蒸发器输出浓度的影响。方法 14例地氟吸入全麻病人。采用Ohmeda210麻醉机,5.0L/min,高流量,Tec6地氟醚蒸发器的输出刻度分别设置为6%和3%,集资使用5种不同载体气体;100%O2,70%O2 30%N2O,30%O2 70%N2O,70%O2 30%N2,30%O2 70N2。每更换一次载体气体间隔10min,每组载体气下分别采集40人次样本,用DatexULT-V麻醉气体监护仪监测地氟醚蒸发器实际输出浓度（FIdes)。结果 不同载体气体明显蜞ec6地氟醚蒸发器的FIdes,随着载体气体O2浓度地降低FIdes明显下降,相同O2浓度下N2O作为载体气较N2对FIDes的影响明显。结论 Tec6地氟醚蒸发器物实际输出浓度受载体气O2浓度和N2O的影响。     

双活瓣式加氧雾化吸入面罩的研制及临床应用研究

将肺心病８０例随机分为观察组和对照组,分别应用双活瓣式加氧雾化吸入面罩与传统面罩进行超声雾化吸入,监测两组雾化吸入前后ＰａＯ２、Ｐａ－ＣＯ２和ＳａＯ２的变化及症状和体征。结果显示：应用双活瓣式加氧雾化吸入面罩除能湿化气道,稀释痰液,解除痉挛,消炎止喘外,还能通过加氧和双活瓣的单向阀作用,有效地克服传统面罩雾化吸入可能引起的低氧血症和二氧化碳潴留等弊端,明显优于传统面罩法     

不同剂量布地奈德混悬液吸入治疗AECOPD165例疗效观察

目的:探讨布地奈德混悬液吸入治疗慢性阻塞性肺疾病急性加重期(AECOPD)的临床疗效与安全性。方法:将165例慢性阻塞性肺疾病(COPD)急性加重期患者随机分为大剂量激素吸入组(A组,42例)、一般剂量激素吸入组(B组,40例)、甲强龙组(C组,42例)和对照组(D组,41例)。四组均接受常规治疗,A组在此基础上雾化吸入布地奈德混悬溶液2mg/次,每日2次;B组吸入布地奈德混悬溶液1mg/次,每日2次;疗程均7d。C组予甲强龙40mg/日静点,好转后改为甲泼尼龙片8mg/d口服,共7d。分别于治疗前和治疗第3、7天测定肺功能、血气分析、呼吸困难评分以及记录不良反应。结果:治疗后第3天,A组及C组各参数与D组比较有显著性差异(P<0.05)。治疗后第7天,A、B、C三组与D组比较均有显著性差异(P<0.05)。而A组与B组组间比较无显著性差异(P>0.05)。吸入激素的局部不良反应主要有咽部不适、声音嘶哑等,均明显低于C组(P<0.05)。结论:大剂量吸入布地奈德混悬液治疗AECOPD疗效较为确切。     

可必特联合普米克令舒氧气雾化吸入治疗慢性阻塞性肺疾病AECOPD效果分析

目的 探讨可必特联合普米克令舒氧气雾化吸入治疗慢性阻塞性肺疾病(COPD)临床效果.方法 选取88例患者,均分为治疗组和对照组,对照组实施常规治疗,观察组加用可必特联合普米克令舒氧气雾化吸入,比较两组血气分析和肺功能变化情况,评价治疗效果和不良反应.结果 治疗后两组PCO<,2>较治疗前均下降(P<0.05),PO<,...     

Prehospital EMS Treatment of Pediatric Asthma and What Happens Before Help Arrives?

Many asthmatic children require assistance by emergency medical services (EMS) secondary to an acute asthma episode. What medication interventions are being utilized by EMS when responding to an asthma call for a child, and how does EMS management compare to home management given before ambulance arrival (pre-EMS)? Sixty-one ambulance reports pertaining to acute asthma episodes in children aged 1 month to 15 years were collected and analyzed. There was no significant difference between likelihood to receive a beta₂-agonist nebulizer treatment pre-EMS arrival or by EMS. Oxygen was the most common EMS intervention.     

超声心动图对雾化吸入硝普钠治疗先天性心脏病肺动脉高压疗效的评价

目的 观察雾化吸入硝普钠治疗小儿先天性心脏病肺动脉高压的疗效.方法 选择28例超声确诊伴有肺动脉高压的先天性心脏病患儿,应用超声心动图于雾化吸入硝普钠（5 mg/ml）前、吸入30 min后分别测量、计算肺动脉收缩压（PASP）、肺动脉舒张压（PADP）、左右心Tei指数及左心室射血分数（LVEF）、左心室短轴缩短率（LVFS）;同时在雾化吸入硝普钠前及后5、10、20及30 min观察血氧饱和度（SaO2）、血压、心率的变化.结果 与雾化吸入硝普钠前相比,吸入30 min后PASP、PADP、Tei指数均有下降（P＜0.01）,SaO2吸入5 min后有升高趋势（P＜0.01）,而血压、心率在吸入后5、10、20及30 min各时间点与吸入前相比差异无统计学意义（P＞0.05）.结论 超声心动图可评价雾化吸入硝普钠治疗先天性心脏病肺动脉高压的疗效,证实雾化吸入硝普钠可选择性降低肺动脉压力,改善心功能,提高动脉氧分压.     

定量雾化器改良高渗盐水支气管激发试验在不同年龄段哮喘诊断中的价值研究

目的　探讨定量雾化器改良高渗盐水支气管激发试验（简称改良激发试验）在不同年龄段哮喘诊断中的应用价值。方法　选取2016年2月—2017年2月在广东省中医院门诊就诊的因临床疑诊哮喘而行改良激发试验的患者1 094例,根据世界卫生组织（WHO）关于年龄段的划分标准,将患者分为5~17岁为少年组（n=148）、18~59岁为中青年组（n=835）、≥60岁为老年组（n=111）。患者均行常规肺功能检测及改良激发试验,比较不同年龄组改良激发试验阳性率和不良反应发生率。结果　患者改良激发试验阳性率为16.2%（164/1 094）,其中少年组、中青年组、老年组改良激发试验阳性率分别为35.8%（53/148）、11.1%（93/835）和12.6%（18/111）,3组改良激发试验阳性率比较,差异有统计学意义（χ2=60.201,P<0.01）。其中中青年组、老年组改良激发试验阳性率低于少年组（P<0.01）。3组患者行改良激发试验后,均未出现哮喘大发作等严重不良反应,常见的不良反应为咳嗽、胸闷、气紧、喘息、气促、咽痒等。3组胸闷、气紧、喘息、气促、咽痒、其他不良反应发生率比较,差异均无统计学意义（P>0.05）;3组咳嗽发生率比较,差异有统计学意义（P<0.05）。结论　改良激发试验适合不同年龄段哮喘患者的诊断,尤其适用于儿童。     

振动筛网雾化器与压力射流雾化器在雾化时间和雾化后残余量中的差异研究

背景　雾化吸入器依据装置工作原理的不同分为压力射流雾化器、超声雾化器和振动筛网雾化器。振动筛网雾化器近年在国内逐渐发展，但目前对振动筛网雾化器研究较少。目的　比较振动筛网雾化器与压力射流雾化器雾化时间和雾化后残余量的差异。方法　2019-05-19至2019-06-19，分别选择三种品牌压力射流雾化器与对应的振动筛网雾化器（分别记为A、B、C），采用平行队列分析法，比较三种品牌压力射流雾化器与相对应的振动筛网雾化器在雾化6 ml 0.9%氯化钠溶液时所需的雾化时间及雾化后残余量；并比较三种品牌振动筛网雾化器在雾化6 ml 0.9%氯化钠溶液时所需的雾化时间和雾化后残余量。结果　A、B、C品牌压力射流雾化器雾化6 ml 0.9%氯化钠溶液所需的雾化时间长于振动筛网雾化器，雾化6 ml 0.9%氯化钠溶液后残余量多于振动筛网雾化器（P<0.05）；三种品牌压力射流雾化器雾化6 ml 0.9%氯化钠溶液所需的平均雾化时间〔（21.35±2.26）min〕长于振动筛网雾化器〔（13.55 ±2.92）min〕（Z=-6.42，P<0.05）。三种品牌压力射流雾化器雾化6 ml 0.9%氯化钠溶液后平均残余量〔（0.47 ±0.05）ml〕多于振动筛网雾化器〔（0.03±0.02）ml〕（Z=-6.67，P<0.05）。B、C品牌振动筛网雾化器雾化6 ml 0.9%氯化钠溶液所需的雾化时间均短于A品牌振动筛网雾化器（P<0.05）；B品牌振动筛网雾化器雾化6 ml 0.9%氯化钠溶液后的残余量多于A品牌振动筛网雾化器，C品牌振动筛网雾化器雾化6 ml 0.9%氯化钠溶液后的残余量少于A品牌振动筛网雾化器（P<0.05）。结论　雾化6 ml 0.9%氯化钠溶液时，振动筛网雾化器雾化所需的雾化时间及雾化后残余量均少于压力射流雾化器，值得在临床和家庭推广使用。