BACKGROUND: Aerosol and humidification therapy are used in long-term airway management of critically ill patients with a tracheostomy. The purpose of this study was to determine delivery efficiency of jet and mesh nebulizers combined with different humidification systems in a model of a spontaneously breathing tracheotomized adult with or without exhaled heated humidity. METHODS: An in vitro model was constructed to simulate a spontaneously breathing adult (tidal volume, 400 mL; breathing frequency, 20 breaths/min; inspiratory-expiratory ratio, 1:2) with a tracheostomy using a teaching manikin attached to a test lung through a collecting filter (Vital Signs Respirgard II). Exhaled heat and humidity were simulated using a cascade humidifier set to deliver 37°C and >95% relative humidity. Albuterol sulfate (2.5 mg/3 mL) was administered with a jet nebulizer (AirLife Misty Max) operated at 10 L/min and a mesh nebulizer (Aeroneb Solo) using a heated pass-over humidifier, unheated large volume humidifier both at 40 L/min output and heatand-moisture exchanger. Inhaled drug eluted from the filter was analyzed via spectrophotometry (276 nm). RESULTS: Delivery efficiency of the jet nebulizer was less than that of the mesh nebulizer under all conditions (P < .05). Aerosol delivery with each nebulizer was greatest on room air and lowest when heated humidifiers with higher flows were used. Exhaled humidity decreased drug delivery up to 44%. CONCLUSIONS: The jet nebulizer was less efficient than the mesh nebulizer in all conditions tested in this study. Aerosol deposition with each nebulizer was lowest with the heated humidifier with high flow. Exhaled humidity reduced inhaled dose of drug compared with a standard model with nonheated/nonhumidified exhalation. Further clinical research is warranted to understand the impact of exhaled humidity on aerosol drug delivery in spontaneously breathing patients with tracheostomy using different types of humidifiers.
This study aimed to measure the level of vaccine hesitancy among the Saudi population using the WHO Vaccine Hesitancy Scale (VHS). A cross-sectional study using a modified vaccine hesitancy scale (VHS) was conducted among Saudi Arabian residents between April 4 and May 24, 2021. The relationship between participants' willingness to uptake COVID-19 vaccines and their demographics, awareness of COVID-19, and health status was evaluated. The chi-square test was employed to compare categorical variables and logistic regression for the associations of demographical characteristics with acceptance of the vaccine. We received a total of 1657 completed responses. 1,126 participants (68%) were vaccinated, of which 19% were vaccinated with one dose only, and 49% were fully vaccinated (with two doses). Safety concerns and worries about side effects were higher among the hesitant group (p<0.001). 96% of the participants from the willing group were not hesitant to have the vaccine, whereas in the same group, 70% thought they had good health and the vaccine was not needed. Logistic regression analysis revealed that participants with chronic diseases had lower odds of being willing to be vaccinated (OR=0.583, p-value 0.04). The study findings suggest key factors associated with COVID-19 vaccine hesitancy in the Saudi population and can help public health authorities plan strategies to minimize vaccine hesitancy and improve awareness about vaccine acceptance.
BackgroundDysponea, muscle wasting, and fatigue are common manifestations in interstitial lung disease (ILD). Pulmonary rehabilitation programmes (PRP) aim to improve symptoms and quality of life in ILD but research is very limited about the role and feasibility of inspiratory muscle training (IMT) in PRP.MethodsSix patients with a mixed disciplinary team diagnosis of ILD (5 males, median age 80 range 67–85) participated in a tailored PRP either in an IMT (n=3) or control group (n=3). PRP involved three days of exercises, one conducted in a hospice day therapy unit and two at home. The PRP session involved aerobic, strength, and stretching exercises with integrated education and relaxation sessions. Both groups received the same PRP, supplemented in the IMT group by the use of a POWERbreathe Medic plus respiratory muscle trainer. The trainer use consisted of 30 breaths twice daily with personalised resistance levels of 40% Maximal Inspiratory Pressure (MIP), which was measured and adjusted weekly. ILD outcome measures were recorded before and after PRP.ResultsAll patients completed the PRP with adherence of ≥80% for the full program. There were no major complications or adverse events and patients reported liking and enjoying the PRP and environmental setting. Table 1 report the PRP outcomes. Description: there was a considerable prevalence of baseline limitation in term of depression, anxiety, fatigue severity scale (FSS), forced vital capacity (FVC) and six-minute walk test (6MWT). These limitations were maintained after PRP and there was a reduction in FVC in both groups, consistent with disease progression. In the IMT group there was a trend for an improvement in MIP, 6MWT, FSS, and visual analogue fatigue scale and a maintenance of quadriceps strength when compared with the control group.Abstract P159 Table 1IMTControl OutcomesNormal ValuesBefore PRP (mean±SD)After PRP (mean±SD)Before PRP (mean±SD)After PRP (mean±SD) K-Bild 10570.0+1572±568±1469±12Depression 0–74±2.644.67±0.5776.33±5.775.33±6.65Anxiety 0–76±1.736.33±0.5775.0±2.6464.33±3.22FSS 946±2041±745.0±12.45±15Visual analogue Fatigue scale102.67±2.086.5±0.713.33±0.5774.67±3.51MIP (mmHg) (n=65 to 75)43±12.161.44±18.366.23±38.752.16±35.23FVC (L) 3.13±0.33 2.5±0.522.45±0.782.3±0.79Quadriceps strength(Newtons)289±67286±6328±164294±1216MWT (M) 380±49425±21355±207351±224The table reports the mean and standard deviation of outcomes measured in the pulmonary rehabilitation program.6MWT, six-minute walk test; IMT, inspiratory muscle training; SD, standard deviation; MIP, maximum inspiratory pressure; FVC, forced vital capacity; FSS, fatigue severity scale; KBild, King’s Brief Interstitial Lung Disease health status questionnaire.ConclusionWe believe this is the first description of a successful pilot of bespoke ILD PRP in a hospice and home setting. The PRP was acceptable and appreciated by both patients and healthcare professionals. IMT during PRP for ILD in a hospice setting is feasible and longitudinal measurements of fatigue, 6MWT, and MIP were practica...
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