Health & Environmental Research Online (HERO)


Print Feedback Export to File
2625668 
Journal Article 
Abstract 
Aerosol delivery to spontaneously breathing pediatric patients with a tracheostomy 
Willis, LD; Berlinski, A 
2010 
Yes 
American Journal of Respiratory and Critical Care Medicine
ISSN: 1073-449X
EISSN: 1535-4970 
181 
A6228 
English 
WOS:000208771004587 
is part of a larger document 3452678 Proceedings of the American Thoracic Society 2010 International Conference, May 14-19, 2010, New Orleans
RATIONALE: Currently there are no standards for administration of aerosols to children with a tracheostomy. It is suspected that practices vary widely among institutions. The purpose of this study is to compare practices for administering aerosolized medications to spontaneously breathing pediatric patients with a tracheostomy among teaching institutions that train pediatric pulmonologists.

METHODS: Respiratory care departments of children's hospitals with an ACGME accredited pediatric pulmonary fellowship program were contacted by telephone by one of the authors and invited to participate in a voluntary survey. The survey included demographic data and questions about the use of metered dose inhaler (MDI), updraft nebulizer (NEB), dry powder inhaler (DPI), medications and factors influencing choice of aerosol delivery for spontaneously breathing pediatric patients with a tracheostomy. Factors influencing the choice of aerosol delivery were ranked on a scale of 1-5 with 5 being the most important and 1 not important. Descriptive statistics were used to summarize results.

RESULTS: There was 81% (38/47) participation. Eight, 9, 11 and 10 hospitals were located in the west, south, midwest and northeast regions respectively. 68% were freestanding children's hospitals. The median number of beds was 100-299. 92% used MDIs with 66%, 31% and 3% of the programs using 1, 2 and 3 different delivery techniques respectively. 69%, 57% and 11% used a valved holding chamber, hyperinflation and a non-valved spacer respectively. 97% used NEBs with 67%, 30% and 3% using 1, 2 and 3 different techniques respectively. 89%, 32%, 11%, and 3% used a trachestomy aerosol mask, hyperinflation with resuscitation bag, t-piece and in-line with heated tracheostomy collar respectively. No DPI usage was reported. The most and least frequent factors influencing the method of aerosol delivery were cooperation and insurance preferred drug list with a median of 5 and 3 respectively. Patient cooperation (29%) and MD preference (21%) were the single most important factors used to determine which delivery method is used. Only 5% of institutions used an objective measurement to aid in the choice of delivery method.

CONCLUSION: A wide variation in aerosol delivery practices for tracheostomized spontaneously breathing children is present among teaching institutions that train pediatric pulmonologists. In-vivo and in-vitro studies are needed to asses the efficiency of different practices so recommendations can be made. 
American Thoracic Society 2010 International Conference 
New Orleans, LA 
May 14-19, 2010