Respiratory care : the official journal of the American Association for Respiratory Therapy

102 Pages·1994·6.3 MB·English

by  American Association for Inhalation Therapy

March 1994
Volume 39, Number3
RE/PIRiKTORy
A MONTHLYSCIENCEJOURNAL
39TH YEAR—ESTABLISHED 1956
DecreasingtheWorkofBreathing:
Callfor How Much ofaChange Is Important?
1994Open ForumAbstracts
RelativeAgreementbetween Raman
and MassSpectrometryforMeasuring
End-Tidal Carbon Dioxide
CPAP PerformanceCharacteristicsof
the Puritan-Bennett7200aand a
Prototype Continuous
Pressure-Regulating Ventilator
Evaluation ofan Educational Program
forAsthmaticChildren Ages4-8and
Their Parents
Symposium Papers: Cost-Effectiveness
of RespiratoryCare inthe ICU
j^
MobilizationofSecretionsinICUPatients
ManagingthePatient-VentilatorSystem:
40thAnnualConventionand Exhibition SystemChecksandCircuitChanges
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A Special Conference presented by
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Dallas, Texas
Therapist-DrivenProtocols: TheState-of-the-Artisa2-dayconferencepresenting
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RE/PIRATORy CARE
AMonthlyScienceJournal.Established 1956.OtticialJournalottheAmericanAssociationtorRespiratoryCare.
EDITORIALOFFICE CONTENTS March 1994
D1a1l0l3a0sATbXie7s5L2a2n9e Volume39,Number3
[phone]
MANAGINGEDITOR
RayMasferrerBARRT EDITORIALS
EDITOR 187 DecreasingtheWorkofBreathing:HowMuchofaChangeIs
PAKaaSlySeBOrWoCeuIbgAheeTrrEMBSEADRRIRRTTTOR bIympRoircthaantr?dDBranson—Cincinnati, Ohio
ASSISTANTEDITOR ORIGINALCONTRIBUTIONS
DonnaStephensBBA
EDITORIALBOARD 190 RelativeAgreementbetweenRamanandMassSpectrometryfor
TDRihecaohnmaarHsdesDAsBBMraEarnndessoRnRETRd,RDCTRhaRiTrman Ml}eyaJsouhrninMgGErnda-yThiedaailaCnadrbGaoinfiDeilodxiBdeRussell—Hershey,Pennsylvania
CrystalLDunlevyEdDRRT
CThhaormlaessGDDEuarsbtiPnhJDrMD 195 AComparisonofCPAPPerformanceCharacteristicsofthe
NeilRMaclntyreMD Puritan-Bennett7200aandaPrototypeContinuousPressure-Regulating
JJSohaesmleelpsehyKLCSRtMaoiluslehProheMDDMRERdTRRT bVyenRtoilnaatlodrLTobiaandRussellJFischer—MurrayHill,NewJersey
CONSULTINGEDITORS
FrankEBiondoBSRRT 204 EvaluationofanEducationalProgramforAsthmaticChildrenAges4-8
HRoobwearrtdLJCBhiartenbbuamunRiRMTD andTheirParents
PDaotnraiclidaRAnEnltDoonoMrlDeyMSRRT b\Danie—lADetwiler,LindaMurphyBoston,andStevenJ
RobertRFluckJrMSRRT Verhulst Springfield,Illinois
RonaldBGeorgeMD
JamesMHurstMD SYMPOSIUMPAPERS
CharlesGIrvinPhD
MRoSbeJratstMremKsakcimaMrDekPhDRRT 213 MobilizationofSecretionsinICUPat—ients
HughSMathewsonMD byMarcAJudsonandStevenASahn Charleston,SouthCarolina
MichaelMcPeckBSRRT
JDoahvnidShJiPgieeorksaonMMDD 227 ManagingthePatient-VentilatorSystem:SystemChecksandCircuit
JackWangerMBARPFTRRT Changes
JeffreyJWardMEdRRT —
byRobertSCampbell Tampa,Florida
JOURNALASSOCIATES
StephenMAyresMD
ReubenMCherniackMD CLASSICREPRINTS
DonaldFEganMD
GarethBGishMSRRT 237 RetrospectroscopeREDUX:WhatMakestheSkyBlue?
GAekoergGreeGnrveigkoMryDMD bvJuliusHComroeJr(reprinted, withpermission,fromtheAmericcm
HFrederickHelniholzJrMD ReviewofRespiratoryDisease1976:113:219-222)
JohnEHodgkinMD
TWihlolmiaasmLFMPeitltlyerMMDD TESTYOURRADIOLOGICSKILL
AHleannniKngPiPeorncteoMppDidanMD 242 HemoptysisandDyspneainaYoungWoman
JBoahrrnyWASSehvaepriirnoghMaDusMD bLyasPkaouwlskLia—ngeCl,evKeelvainnd,McOChairothy,JcmiesKStoller,andDaniel
PRODUCTIONSTAFF
LindaBarcus DonnaKnauf
SteveBowden JeannieMarchant
BillCryer
RespiratoryCare(ISSN009891421isamonthlypublicationofDaedalusEnterprisesIncfortheAmericanAssociationforRespiratoryCare.Copyright"^1994byDaedalusEn-
terprisesInc.11030AbiesLane.DallasTX75229.Allrightsreserved.Reproductioninwholeorinpartwithouttheexpress,writtenpermissionofDaedalusEnterpnsesInc.is
prohibited.TheopinionsexpressedinanyarticleoreditorialarethoseoftheauthoranddonotnecessarilyreflecttheviewsofDaedalusEnterprisesInc,theEditorialBoard,or
theAmericanAssociationforRespiratoryCare.NeithercanDaedalusEnterprisesInc,theEditorialBoard,ortheAmercianAssociationforRespiratoryCareberesponsiblefor
theconsequencesoftheclinicalapplicationsofanymethodsordevicesdescribedherein.PrintedinUSA.
RespiratoryCareisindexedinHospitalLileralureImliwandinCumulaliveIndextoNursingandAlliedHealthLiterature.
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RESPIRATORYCARE•MARCH'94Vol39No3 171
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MANUSCRIPTSUBMISSION CONTENTS, March 1994
InnesatrrutchteioennsdloofrRAeustphiorrastoaryndCaTryepiosntsaisquparritenrtleyd Volume39,Number3
basis(Jan,Apr.July.Nov).
PHOTOCOPYING&QUOTATION BOOKS,FILMS,TAPES,&SOFTWAREREVIEWS
PHOTOCOPYING. Anymaterialinthisjournal 251 CriticalCare,editetibyJosephMCivettaMD,RobertWTaylorMD,
tpmhoaastyesisboecfosppcyhireointtgoihcftioecpdioerbdyedDfuoacraetdinaoolnnuacslomEanmdteverarinpccriiesamelesn.tp.uIrn-c arenvdiReowbeedrbtyKRiorbbeyrMtDH.arwwiothod1—31Atcloannttrai.buGteorosrgia
QsiUonO,TqAuTotIeONup.toAn5y0o0newormdasy,ofwmiattheoruitalpeinrmtihsi-s 252 PulmonaryDiseaseintheElderly,editedbyDonaldAMahler,with
jpcorouimrsmenesarlcIintcha,altpuirssoe.vcioadpneyddripgtrhhoetveidqdueobdtyaRtkDisaopenidraaitslourfs'oirEnCntaoernre-- 2r5evcioenwterdibbuytoSrhsirleyMPfister—Denver, Colorado
iscredited.Longerquotationrequireswrittenap-
provalbytheauthorandpublisher. 253 PulmonaryDiseasesandDisorders.2ndedition.Companion
SUBSCRIPTIONS/CHANGESOF Handbook,editedbyAlfr—edPFishmanMDandRobertM KotloffMD
ADDRESS reviewedbyKayeWeber Dallas, Texas
RespiratoryCare
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DallasTX75229-4593 LETTERS
[phone] 254 AnAccurateAssessmentofPeakFlow
—
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5,000 members—$4.00, 5,001-10,000 mem- 174 SummariesofPertinentArticlesfromOtherJournals
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RESPIRATORYCARE•MARCH "94Vol39No3 173
G
Abstracts
SummariesofPertinentArticlesinOtherJournals
Editorials,Commentaries,andReviewsToNote
Excessive Daytime Sleepiness, Upper A—irway Resis- Hemodynamic Monitoring: A New Day Dawning (ed-
tance,and Nocturnal Arousals (editorial) JW Shepard. itorial)—LDNelson.CritCareMed 1993;2I(11):I626.
Chest 1993;104:665. (PeilalnstoGuillemitiaultetal paper
abstractedonPage 175.) Death Due To Asthma: New Insights into Sudden Un-
expectedDeaths,buttheFocusRemainsonPrevention
(editorial)—RCStrunk.AmRevRespirDis 1993;148:550.
Pressure-Controlled Inverse Ratio Ventilation: What
Have We Learned? (editorial)—MJ Gurevitch. Chest Allergen-Specific Treatment for Asthma: HI (editori-
1993:104:664.(PertainstoMercatelalpaperabstractedon al)—TAEPlatts-Mills.AmRevRespirDis 1993:148:553.
Page 181.)
The Imniunoevasive Activities of Pseudomonas ae-
TNreemaatnm.eNntEnogflJMuMletdidr1u99g3-:R3e2s9i:s7t8a4n.t Tuberculosis—MD rruegviinewo)sa—:AReBluerveta.ncAeWforCriCpypsst.icAFmibRreos\isRe(ssptiarte-Doifs-th1e9-9a3r:t
148:793.
The Use ofPulse Oximetry during Conscious Sedation Regional Blood Flow and Oxygen Transport: Implica-
— —
(council report) Council on Scientific Affairs, American tionsfortheTherapyoftheSepticPatient(editorial)
MedicalAssociation.JAMA 1993:270(12):1463. Gutierrez.CritCareMed 1993;21(9):1263.
Occurrence ofOccupational Asth- occupational asthma. After adjusting Various human pulmonary diseases
—
ma STimmer, KRosenman. Chest for the difference in response rate arecharacterizedbyan increasedox-
1993:104:816. among patients from the three hos- idant burden on the respiratory epi-
pitals, the percentage of adult asth- thelial surface. As a step toward de-
To estimate the percentage of adult matics in Michigan whose asthma is veloping a therapy to augment the
asthmatics with occupational asthma causedbyworkexposureisestimated antioxidant defenses of respiratory
inMichigan,asampleof94patients. tobebetween3%and20.2%. Incon- epithelial lining fluid (ELF) of the
aged 20 to 65 years, who were dis- trast, 25.5% of the patients stated human lung, we have evaluated the
charged from one ofthree Michigan their asthma was caused by bad feasibility of aerosolizing a human
hospitals in 1990 with the primary working conditions. If these per- protein antioxidant to the respiratory
diagnosis of asthma were inter- centages were generalizable to the epithelial surface ofan experimental
viewed. The patients were classified whole state, then according to our animal sufficiently large to permit
using the National Institute for Oc- survey330to2,222orbyself-reports repetitive sampling of ELF. To
cupational Safety and Health (NI- of the patients, 2,800 of the 11,000 accomplish this, recombinant human
OSH) criteria as having either prob- hospitaldischarges peryearin Mich- Cu*^fZn**superoxidedismutase(iSOD)
able occupational asthma, possible igan for asthma among adults could wasaerosolizedtosheep,andthelev-
occupational asthma, or not having beattributedtoaworkexposure. els of human superoxide dismutase
occupational asthma. Three percent (SOD) and antisuperoxide anion
of the adult asthmatics interviewed (O; ) capacity were quantified in
met the criteria for having probable Aerosolization of Superoxide Di.s- ELFovertime.In-vitroaerosolization
occupational asthma. One patient mutase: Augmentation of Respira- did not alter the specific activity of
from each hospital had probable oc- tory Kpithelial Lining Fluid Anti- rSOD (p > 0.5). In-vivo aerosoliza-
cupational asthma. Fifteen of60 pa- oxidantScreenbyAerosoli/.ationof tionofrSOD(100mg) tosheep(n=
t2i5entpsati(e2n5t%s)(1f2r7ofm) fHrosopmitHaolspAi,tal.3 Bo.f SRuepceormobxiindaentDi.Hsmuumtaasne—CAu'VGiZlnli*s*- 7m)anreCsuul'teVdZni"n pSeOakDainmoEuLnFtsofof3.1hu±-
and 2 of the 9 patients (22%) from scn..IH Rouni. RF Hoyt, RGCrystal. 0.6 /ymol/L, with a parallel increase
Hospital (' iiaci |in)bablc or possible Chest I993;i()4:81l. in the anli-O: capacity of ELF. For
174 RESPIRArORYCARE• MARCH "94Vol39No3
ABSTRACTS
thedurationofthestudy(5h),levels abrupt but limited reduction in tidal metered dose inhaler and 40 others
of SOD and anti-O:' in ELF re- volume (ie. abnormal increase in (FEV,: 1.08±0.52L: 35 ± 16% pre-
mained elevated, with a value 50% upperairwayresistanceduringsleep). dicted) received wet nebulization.
ofthe peak at5 h. Aerosolization of The arousal restores normal breath- RESULTS:Twenty-sixpatients(65%)
phosphate-buffered saline (n=5) had ing. Snoringwasnotedinassociation receiving metered dose inhaler and
no effect on SOD or anti-O:" levels with these transient arousals in 10of 30 (75%) receiving wet nebulization
in ELF. In animals receiving rSOD, the 15 subjects: however, snoring achievedmaximalbronchodilationaf-
there was no change in the specific was neither sufficient nor necessary ter two doses. Almost all reached
apWllciaatevrriegevredicetodytnaoocnbftliyhumSedaOaseletDratrowrhtsiaieotntclghorvmteSaoprtOreetedDrhsieieancrlavEE(anLLptFFib>oecn0oo.fd4meo)--.af fsrsaoetynrupnadrdtiteroehsoemdemnyetis.edtudehbnaBjtiteoincftttiwhschaaestshiaeoafxmnfdeieslcodtuflwepyedptrhegeaerrbonceuaolqpiiru.nrmaiawlAclalla.yyll em000ss...ha.746ix1p98i)T.mh±LwaealA0fs.obF6rr1ssEoiemVngeLencntIiheffoiioridrcmneiapdlnwbrateotodttivolhoseinnednegebbariuybrnolyhiufarzpolees0uelr.rra7t(d(2iampoonesn±=-d--
sostpfaencStiiOfaiDlciannaccdrteitavhiseteyanintain-bd0o:t"htchtaahpteacaiatmyosucunabtn- Nptoraoeslsa,sluerel,cimoinuntsaietndeudouastsheapndosaiyettixivpmeeeriamsileernewtpaaiyl- tuoelfirzeeadrlbdruots=eer0o.iln9h8aa)lnebdretrcwh=eaen0n.g9et4h:eiwnleotgFEdnVoe|sb.-e
be achieved fora period oftime ap- ness (multiple sleep latency mean About 1/6 the wet nebulizer dose of
plicable to human therapy, support- score= 13.5 min), thetransientarou- albuterol was neededto achieve sim-
ing the rationale for evaluation of sals (mean alpha EEG arousal index ilar response to the metered dose in-
rSOD aerosol as an antioxidant in decreased from 31.3 ± 12.4 to 8 ± 2 haler.CONCLUSIONS: Albuterolby
humanpulmonarydisease. perhourofsleep), and the abnormal metereddoseinhalerprovidedsimilar
upperairwayresistance.Chronicday- bronchodilation to that achieved by
A Cause of Excessive Daytime time sleepiness is a major cause of wet nebulization in patients with a-
Sleepiness: The Up—per Airway social, economic, and medical im- cute asthma. The cumulative dose-
Rnaeuslits.tRancSteooShysn,dAroCmleerk,CMGuCieltleelm,iP- pdariormmeenta.ndRietcsocganuisteionis iomfpotrhtiasnts,yna-s rtheespoenmseergteenchcnyiqudeepiasrtampepnlticasbeltetinign
Maistros.Chest 1993:104:781. specific treatments can be developed and is helpful in comparing the rela-
toeliminatetheproblem. tive utility of various bronchodilator
Subjects with isolated complaints of regimens.
chronicdaytimesleepinessareusual- A Comparison of Albuterol Ad-
ly classified as "idiopathic hyper- ministered by Metered Dose In- Environmental Tobacco Smoke
somniacs" and treated symptomat- haler (and Holding Chamber) —or ConcentrationsinNo-Smokingan—d
ically. Agroupofthese subjectswas Wet Nebulizer in Acute Asthma SmokingSectionsofRestaurants
investigated during nocturnal sleep A Colacone, M Afilalo, N Wolkove, WE Lambert, JM Samet, JD Spen-
and daytime naps. In a subgroup of HKreisman.Chest 1993:104:835. gler. Am J Public Health 1993:83:
them, sleep was fragmented by very 1339.
shortalphaEECarousalsthroughout BACKGROUND: Comparative stud-
the sleeping period. These short ies of albuterol by wet nebulizer or Tocharacterizetheeffectivenessofa
arousals are usually ignored in sleep metered dose inhaler have tested localordinancethatrestrictssmoking
analyses, but their impact is sig- fixeddosesofmedications. Wecom- inrestaurantstoonethirdoftheseat-
nificant (inthe 15 subjects identified pared the dose-response relationship ing area, this study made simultane-
with the syndrome, the mean sleep to albuterol by wet nebulization or ous measurements oftwo markers of
latency in multiple sleep-latency tests metereddoseinhalerinacuteasthma. environmentaltobaccosmoke,respir-
was5.1 ± 1 min).These arousalsare METHODS: Randomized, double- ablesuspendedparticlesandnicotine,
directly related to an abnormal in- blind, placebo-controlled trial. Pa- in the smoking and no-smoking sec-
crease in respiratory efforts during tients with acute asthma received ei- tions ofseven restaurants. The mean
sleep (the mean peak inspiratory ther albuterol, 0.4 mg, by metered concentrations of respirable sus-
esophagealpressure measured in our dose inhaler (and holding chamber) pended particles and nicotine were
subjects in the respiratory cyclejust oralbuterol,2.5 mg,bywetnebulizer 40% and 65% lower, respectively, in
preceding a transient arousal was every 30 min until maximal bron- the no-smoking than in the smoking
-33±7cmH:0).Typically,anarou- chodilation. Forty patients (forcedex- sections, indicating substantial but
saloccurswithinonetothreebreaths piratoryvolumein 1 s[FEV|]: 1.15± not complete protection against ex-
of flow limitation associated with 0.43 L: 36± 12%predicted)received posure.
RESPIRATORYCARE• MARCH'94Vol39No3 175
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