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Respiratory Therapy > Aerosol Therapy > Flashcards

Aerosol Therapy Flashcards

1
Q

Main Uses of Aerosol Therapy

A
  • Humidification of dry inspired gases
  • Improved mobilization and clearance of respiratory secretions – using bland aerosols, hyper- or hypotonic saline
  • Delivery of aerosolized drugs to the respiratory tract
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2
Q

Particle Size

0.8-3 µm

A

Deposit into alveoli

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3
Q

Particle Size

1-5 µm

A

Deposit into small airways, last 6 generations

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4
Q

Particle Size

5-10 µm

A

Deposit into large airways, first 6 generations

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5
Q

Particle Size

10-15 µm

A

deposit in mouth and nose

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6
Q

Mass Median Aerodynamic Diameter (MMAD)

A
  • Mass median aerodynamic diameter (MMAD) is the size where 50% of the mass of particles will be above this size and 50% will be below this size
  • MMAD is important to determine which nebulizer to use to deliver medication to a target area
    • If you want deposition into small airways you need to use a nebulizer with a lower MMAD
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7
Q

Ultrasonic Nebulizer

A
  • An ultrasonic nebulizer is an electrically powered device operating on the piezoelectric principal
    • High output with small particles sizes
  • They use a piezoelectric crystal to produce aerosols. The crystal converts electrical energy into high frequency vibrations to produce aerosol. Output is directly affected by amplitude setting
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8
Q

What does the aerosol particle size depend on?

A

It depends on the substance being nebulized, the method used to generate the aerosol, and the environmental conditions surrounding the particle.

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9
Q

How are medical aerosols generated in the clinical setting?

A

They are generated with devices that physically disperse matter into small particles and suspend them in gas.

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10
Q

How does a large volume ultrasonic nebulizer work?

A

It incorporates air blowers to carry mist to the patient for delivery of bland aerosol therapy or sputum induction.

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11
Q

What affects MDI performance and drug delivery?

A

Low temperature decreases the output of the CFC MDI’s. Debris build up on nozzle or actuator orifice reduces the emitted dose.

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12
Q

What are 3 examples of aerosol devices?

A

Atomizers, Nebulizers, and Inhalers.

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13
Q

What are 3 factors that determine particle size?

A

The substance being nebulized, the method used, and the environmental conditions.

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14
Q

What are key mechanisms of aerosol deposition?

A

Inertial impaction, Gravimetric sedimentation, and Brownian diffusion.

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15
Q

Small Particle Aerosol Generator (SPAG)

A
  • This is a device that is a large reservoir nebulizer
    • Large amount of the solution and very small particle sizes
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16
Q

The physician has ordered an antiviral agent ribavirin (Virazole) to be administered by aerosol to an infant with bronchiolitis. Which device would you select?

A

SPAG – Small particle aerosol generator.

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17
Q

What serious problems are associated with the delivery of Virazole using the SPAG?

A

Caregiver exposure to drug aerosol, drug precipitation in ventilator circuits.

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18
Q

Small Volume Nebulizers (SVN)

A
  • Either pneumatic (gas powered) that utilize a jet-shearing principle for creation of an aerosol
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19
Q

Factors affecting SVN efficiency

A
  • Dead Volume – minimum volume required in the reservoir to aerosolize the drug – 0.5 to 1.0 ml - only 35% to 60% of a drug solution is delivered from a SVN before sputter
  • Filling Volume and Treatment Time – ideal is 3 to 5 ml at 6 to 8 LPM flow-rate for a treatment time of 10 minutes
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20
Q

What is residual drug volume?

A

Also known as dead volume, it is the medication that remains in the SVN after the device stops generating aerosol and “runs dry.” The residual volume of a 3-ml dose can range from 0.5 to more than 2.2 ml, which can be more than two-thirds of the total dose. Residual volume also depends on the position of the SVN.

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21
Q

What is the technique for using an SVN?

A

Slow inspiratory flow optimizes SVN aerosol deposition. Deep breathing and breath holding during SVN therapy do little to enhance deposition over normal tidal breathing. As long as the patient is mouth breathing, there is little difference in clinical response between therapy given by mouthpiece and therapy given by mask.

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22
Q

A typical SVN is powered by what?

A

It is powered by a high-pressure stream of gas directed through a restricted orifice (the jet).

The gas stream leaving the jet passes by the opening of a capillary tube immersed in solution. Because it produces low lateral pressure at the outlet, the high jet velocity draws the liquid up the capillary tube and into the gas stream, where it is sheared into filaments of liquid that break up into droplets.

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23
Q

Metered Dose Inhalers

A
  • These devices are small pressurized canisters for oral or nasal inhalation of aerosol drugs
  • Caveat: QVAR will deliver meds even if not shaken
  • Loss of dose – new HFA formulation does not suffer from loss of dose
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24
Q

Factors Affecting MDI Performance:

A
  • MDI should be shaken before use to properly mix drug and propellant – med dependant
  • Loss of prime or propellant from the metering valve
  • Loss of dose in the first discharge in the meter valve – no longer an issue with HFA
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25
Q

MDI Reservoir Devices

A

Designed to help the coordinated process of using an MDI by allowing space and time for paricles to decrease in size through vapoization of propellant and evapoartion of initial large partcle sizes

Will slows velocity of particles released from a MDI before reaching the oropharynx

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26
Q

Dry Powder Inhalers (DPIs)

A
  • Consists of a unit formulation of drug in a powder form similar to an MDI
  • These devices are breath-actuated, with turbulent air flow from the inspiratory effort of the user providing the power to create an aerosol of the fine particles of drug
  • Require no propellants
  • Self generated flows of between 30 – 90 lpm are needed for drug deposition – depends on med
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27
Q

Equivalent MDI and SVD

A

Ratio of MDI to SVN ~ 1:2

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28
Q

What are the medication delivery issues for infants and children?

A

They have smaller airway diameters, faster breathing rates, nose breathing filters out large particles, lower minute volumes, and spontaneous patient cooperation can be an issue.

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29
Q

What contributes to aging of aerosols?

A

The composition of aerosol, the initial size of particles, the time in suspension, and the ambient condition.

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30
Q

What does gravimetric analysis measure?

A

Aerosol weight.

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31
Q

What happens to the temperature of a solution placed in an ultrasonic nebulizer?

A

The temperature of the solution increases.

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32
Q

What is aerosol output?

A

The mass (amount) of fluid or drug contained in an aerosol.

33
Q

What is aerosol output rate?

A

The mass (amount) of aerosol generated per unit of time. It varies depending on different nebulizers and inhalers used.

34
Q

What is aging when pertaining to aerosols?

A

The process by which the aerosol suspension changes over time.

35
Q

What is a Metered-dose inhaler (MDI)?

A

A pressurized canister containing the prescribed drug in a volatile propellant combined with surfactant and a dispersing agent.

36
Q

What is a positive response indicated from Continuous nebulization?

A

An increase in peak flow of greater than 10% with a goal of at least 50%.

37
Q

What is an ultrasonic nebulizer capable of?

A

Higher aerosols outputs and higher aerosol densities than conventional jet nebulizers.

38
Q

What is Brownian diffusion?

A

The primary deposition mechanism for very SMALL particles and will deposit DEEP within the lungs.

39
Q

What is gravimetric sedimentation?

A

When aerosol particles settle out of suspension and are deposited due to the pull of gravity. Breath-holding after inhalation increases sedimentation and distribution in the lungs. The greater the mass of a particle, the faster it settles.

40
Q

What is inertial impaction?

A

When aerosol in motion collides with and are deposited onto a surface. The greater the mass and velocity of a moving droplet, the greater the inertia and tendency of that droplet to continue moving along its set path.

41
Q

What is the blow-by technique?

A

It is used if the patient cannot tolerate mask treatment. The aerosol is directed from the nebulizer towards the patients nose and mouth from a distance of several inches from the face.

42
Q

What is the relationship between GSD and the range of particle sizes?

A

The greater the GSD, the wider the range of particle sizes and therefore a more dispersed aerosol.

43
Q

What’s the difference between spacers and holding chambers?

A
44
Q

Why would you prime an MDI?

A

To mix the drug and propellant and to ensure that an adequate dose is provided.

45
Q

What is aerosol aging?

A

The process by which an aerosol suspension changes over time.

46
Q

What is the SPAG?

A

The SPAG was manufactured by ICN Pharmaceuticals specifically for administration of ribavirin (Virazole) to infants with respiratory syncytial virus infection. It incorporates a drying chamber with its own flow control to produce a stable aerosol.

47
Q

What is the baffle?

A

A surface on which large particles impact and fall out of suspension, whereas smaller particles remain in suspension, reducing the size of particles remaining in the aerosol.

48
Q

What are breath-actuated nebulizers?

A

An aerosol device that is responsive to the patient’s inspiratory effort and reduces or eliminates aerosol generation during exhalation.

They can generate aerosol only during inspiration. This eliminates the waste of aerosol during exhalation and increases the delivered dose threefold or more over continuous and breath-enhanced nebulizers.

49
Q

What is a Breath-Actuated Pressurized Metered Dose Inhaler?

A

A variation of a pMDI that incorporates a trigger that is activated during inhalation. This trigger reduces the need for the patient or caregiver to coordinate MDI actuation with inhalation.

50
Q

Breath holding after inhalation of an aerosol does what?

A

It increases the residence time for the particles in the lung and enhances distribution across the lungs and sedimentation.

51
Q

What is Brownian Diffusion?

A

The primary mechanism for deposition of small particles (less than 3um), mainly in the respiratory region where bulk gas flow ceases.

52
Q

What are cascade impactors?

A

They are designed to collect aerosols of different size ranges on a series of stages or plates.

53
Q

Cold air and high-density aerosols can cause what?

A

Reactive bronchospasm and increased airway resistance.

54
Q

Droplet size and nebulization time are inversely proportional to gas flow through the jet?

A

The higher the flow of gas to the nebulizer, the smaller the particle size generated, and the shorter is the time required for nebulization of the full dose.

55
Q

Exhalation into the device before inspiration can result in what?

A

It can result in the loss of drug delivery to the lungs.

56
Q

What is a potential problem with continuous bronchodilator therapy (CBT)?

A

An increase in drug concentration can be adversely given. Patients receiving CBT needs close monitoring for signs of drug toxicity (e.g., tachycardia and tremor).

57
Q

What is sedimentation?

A

It occurs when aerosol particles settle out of suspension and are deposited owing to gravity. The greater mass of the particle, the faster it settles.

58
Q

What is a spacer?

A

A spacer is a simple valve-less extension device that adds distance between the MDI outlet and the patient’s mouth. This distance allows the aerosol plume to expand and the propellants to evaporate before the medication reaches the oropharynx.

59
Q

What are two specific problems that are associated with SPAG use to deliver ribavirin?

A

(1) Caregiver exposure to the drug aerosol,
(2) Drug precipitation can jam breathing valves or occlude the ventilator circuit.

60
Q

A typical SVN is powered by what?

A

It is powered by a high-pressure stream of gas directed through a restricted orifice (the jet). The gas stream leaving the jet passes by the opening of a capillary tube immersed in solution. Because it produces low lateral pressure at the outlet, the high jet velocity draws the liquid up the capillary tube and into the gas stream, where it is sheared into filaments of liquid that break up into droplets.

61
Q

The USN uses a piezoelectric crystal to do what?

A

To generate an aerosol. The crystal transducer converts an electrical signal into high-frequency (1.2- to 2.4-MHz) acoustic vibrations. These vibrations are focused in the liquid above the transducer, where they disrupt the surface and create oscillation waves. If the frequency of the signal is high enough and its amplitude strong enough, the oscillation waves form a standing wave that generates a geyser of droplets that break free as fine aerosol particles.

62
Q

Well-designed baffling systems decrease what?

A

They decrease both the MMAD (size) and the GSD (range of sizes) of the generated aerosol.

63
Q

When ribavirin or pentamidine is given, the treatment is provided where?

A

It is provided in a private room. The room should be equipped for negative pressure ventilation with adequate air exchanges (at least six per hour) to clear the room of residual aerosols before the next treatment. HEPA filters should be used to filter room or tent exhaust, or the aerosol should be scavenged to the outside.

64
Q

When used in conjunction with high-frequency oscillatory ventilation, administration of albuterol sulfate via a VM nebulizer placed between the ventilator circuit and the patient airway has been reported to what?

A

To deliver greater than 10% of the dose to both infants and adults. A pMDI with an adapter placed immediately proximal to the endotracheal tube achieved similar results in adult patients ventilated via high-frequency oscillatory ventilation.

65
Q

Where aerosol particles are deposited in the respiratory tract depends on what?

A

It depends on their size, shape, and motion and on the physical characteristics of the airways. Key mechanisms causing aerosol deposition include inertial impaction, sedimentation, and Brownian diffusion.

66
Q

With continuous or bias flow through the ventilator circuit, the delivery is reduced how?

A

It is reduced as the flow increases, whereas placement of a VM nebulizer near the ventilator increases delivery.

67
Q

How does an atomizer differ from an SVN?

A

Atomizers don’t have baffles. They are usually powered by a hand-squeezed bulb. Because the particles are larger, the drug deposits in the upper airway. You might deliver a local anesthetic through an atomizer prior to bronchoscopy.

68
Q

DPIs require a high inspiration flow of what?

A

60 L/minute

69
Q

What are some of the characteristics of Jet Nebulizer?

A

Cools during operation, provides a small aerosol particle size, and is less expensive.

70
Q

What is the optimal flow rate and amount of solution to put in an SVN?

A

6-8 L/min

71
Q

What are of the characteristics of ultrasound nebulizers?

A

Heats up during operation, Larger aerosol particles, More expensive, and Less noise.

72
Q

What is the aerosol output an ultra sound nebulizer is capable of delivering?

A

0.2 to 1.0 ml/minute.

73
Q
A
74
Q

What will increase aerosol deposition by inertial impaction?

A

Variable or irregular passages and turbulent gas flow.

75
Q

What term describes the primary mechanism for deposition of small particles?

A

Brownian diffusion.

76
Q

Immediately after firing, the aerosol produced by most MDI’s are about how large?

A

35 um

77
Q

Proper use of a dry powder inhaler requires that the patient be able to do what?

A

Generate inspiratory flows of 60 L/min or higher.

78
Q

Normally, when using a 50-psi flowmeter to drive a SVN, you set the flow at what?

A

6–8 L/minute.

79
Q
A

Respiratory Therapy (17 decks)

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