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Vibrating Mesh Nebulizer Compared With Metered-Dose Inhaler in Mechanically Ventilated Subjects.

BACKGROUND: The impact of various aerosol delivery devices on patient outcomes during mechanical ventilation is unknown. If one method of delivery results in a higher ventilator-associated pneumonia (VAP) rate than another, multiple patient outcomes may be affected. This study aimed to determine whe...

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Publicado en:Respiratory Care Vol. 62; no. 4; pp. 391 - 396
Autores principales: Dubosky, Meagan N., Yi-Fan Chen, Henriksen, Mary E., Vines, David L.
Formato: CEU research tables/charts Journal Article
Publicado: Mary Ann Liebert, Inc. Apr2017
Acceso en línea:Ver este registro en EBSCOhost
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      pub: Mary Ann Liebert, Inc.
      place: New Rochelle, New York
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        atl: Vibrating Mesh Nebulizer Compared With Metered-Dose Inhaler in Mechanically Ventilated Subjects.
      aug:
        au:
          Dubosky, Meagan N.
          Yi-Fan Chen
          Henriksen, Mary E.
          Vines, David L.
        affil: Department of Cardiopulmonary Sciences, Rush University Medical Center, Chicago, Illinois
      sug:
        subj:
          Nebulizers and Vaporizers
          Respiration, Artificial
          Human
          Retrospective Design
          Descriptive Statistics
          Data Analysis Software
          APACHE (Acute Physiology and Chronic Health Evaluation)
          Questionnaires
          Record Review
          Odds Ratio
          Midwestern United States
          Confidence Intervals
          Male
          Female
          Two-Tailed Test
          Chi Square Test
          Fisher's Exact Test
          Funding Source
          Education, Continuing (Credit)
          Male
          Female
      ab: BACKGROUND: The impact of various aerosol delivery devices on patient outcomes during mechanical ventilation is unknown. If one method of delivery results in a higher ventilator-associated pneumonia (VAP) rate than another, multiple patient outcomes may be affected. This study aimed to determine whether there was a difference in VAP occurrence and patient outcomes (days receiving ventilation and in-hospital mortality) between the vibrating mesh nebulizer (AeroNeb Solo) and the metered-dose inhaler (MDI). METHODS: This retrospective study reviewed medical records for all mechanically ventilated, adult patients with an order for aerosol treatment from August 2011 to August 2013. The hospital converted from MDI to vibrating mesh nebulizers in August 2012, and data were gathered 1 y before/after conversion. Excluded were patients with a tracheostomy, patients who were mechanically ventilated for <24 h, patients who received a combination of nebulizer and MDI treatments, or patients who were re-intubated. RESULTS: Two hundred twenty-eight subjects were included. Forty-eight (21%) received treatment with an MDI, and 180 (79%) were treated with the vibrating mesh nebulizer. Descriptive data did not significantly differ for age or APACHE II (Acute Physiology and Chronic Health Evaluation D) scores between the groups but did for sex (P = .03). Difference in median days receiving ventilation for the MDI (5 d, interquartile range 3.0-8.5 d) and the vibrating mesh nebulizer (6 d, interquartile range 4.0-10.0 d) was not statistically significant. No correlation was found between the use of either device and the primary outcomes of VAP and in-hospital mortality. In multivariable logistic regression analysis, the number of days receiving ventilation increased the odds of VAP (odds ratio [OR] 1.3, 95% CI 1.14-1.49, P < .001) and mortality (OR 1.12, 95% CI 1.04-1.21, P = .002). Higher APACHE II scores increased the odds ofmortality (OR 1.05,95% CI 1.001-1.092, P = .044). CONCLUSION: We found no association between an MDI or vibrating mesh nebulizer and our primary outcomes, days receiving ventilation, in-hospital mortality, or VAP, in mechanically ventilated subjects.
      pubtype: Academic Journal
      doctype:
        CEU
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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