Early Studies. Then, the Meta-analysis. Recent Studies Al-Ansari. Recent Studies Luo University of Texas Health Science Center at San Antonio
|
|
- Elfrieda Lamb
- 6 years ago
- Views:
Transcription
1 Pediatrics Grand Rounds Objectives Review the available literature on the use of nebulized hypertonic saline in the treatment of acute viral bronchiolitis Review proposed mechanism(s) of action and safety profile for hypertonic saline in bronchiolitis Shawn Ralston, MD Viral bronchiolitis is the leading diagnosis at hospitalization for infants under 1 year of age It results in approximately 150,000 hospitalizations per year at a cost of over $500 million Standard of care in the US (as defined by the AAP Practice Parameter) is symptomatic care Diagnosis and management of bronchiolitis. Pediatrics 2006;118(4): % of all infants in the US will be admitted for bronchiolitis A trial of beta agonist therapy is condoned in the practice parameter but not recommended: RECOMMENDATION 2a Bronchodilators should not be used routinely in the management of bronchiolitis (recommendation: evidence level B; RCTs with limitations; preponderance of harm of use over benefit). RECOMMENDATION 2b Yorita KL, Holman RC, Sejvar JJ, Steiner CA, Schonberger LB. Infectious disease hospitalizations among infants in the United States. Pediatrics 2008;121: Pelletier AJ, Mansback JM, Camargo CA. Direct medical costs of bronchiolitis hospitalizations in the United States. Pediatrics 2006;118: Pathology in bronchiolitis is not beta-agonist reversible airway obstruction Little benefit gained from routine beta-agonist usage, no impact on admission rates or LOS, no impact on oxygen saturation (or a negative impact), minor and equivocal impact on respiratory scores Gadomski AM, Bhasale AL. Bronchodilators for bronchiolitis. Cochrane Database of Systematic Reviews. 2006, Issue 3. Art. No.: CD DOI: / CD pub2 A carefully monitored trial of alpha-adrenergic or beta-adrenergic medication is an option. Inhaled bronchodilators should be continued only if there is a documented positive clinical response to the trial using an objective means of evaluation (option: evidence level B; RCTs with limitations and expert opinion; balance of benefit and harm).
2 And, along comes hypertonic saline.. Sarrell EM, Tal G, Witzling M, Someck E, Houri S, et al. Nebulized 3% saline solution treatment in ambulatory children with viral bronchiolitis decreases symtpoms. Chest 2002;122: Mandelberg A, et al. Nebulized 3% hypertonic saline solution treatment in hospitalized infants with bronchiolitis. Chest 2003;123: Tal G, et al. Hypertonic saline/epinephrine treatment in hospitalized infants with viral bronchiolitis reduces hospitalizations stay: 2 years experience. IMAJ 2006;8: Early Studies Sarell 2002 outpatient trial (n=70), no impact on hospitalization rates, but + impact on respiratory scores, all treatments given with 5mg terbutaline Mandelberg 2003 inpatient (n=52), +impact on both scores and LOS, all treatments given with 1.5 mg epinephrine Tal inpatient (n=41), +impact on both scores and LOS, all treatments given with 1.5 mg epinephrine Leading to the Multicenter Trial Kuzik BA, et al. Nebulized hypertonic saline in the treatment of viral bronchiolitis in infants. J Pediatr 2007;151: Multicenter, Canada and UAE, inpatient (n=96), +impact on LOS with a 30% reduction amounting to about 1 day Then, the Meta-analysis Zhang L, et al Cochrane. Analyzed the three Israeli studies and Kuzik Inpatient pooled results (3 studies, 189 patients) showed a 0.94 day decrease in LOS (CI 1.48 to 0.4) Recent Studies Luo 2009 Luo Zhengxiu, et al. International Pediatrics Chong Qing Medical University Wards. N=93 inpatients, 1.4 d decrease in LOS (6.4 vs. 4.8 days) At least a day off time to resolution of wheezing, cough and moist crackles..whatever those are. Recent Studies Al-Ansari Al-Ansari K, et al. J Peds Infants admitted to a Qatari hospital short stay unit. N=187, no impact on LOS (1.5 d), three arms comparing 5% to 3% to NS, with sig difference in severity scores at 48hr only for 5% vs. NS
3 Recent Studies Luo 2010 Luo Zhengxiu, et al. Clinical Microbiology and Infection Chong Qing group again. N=126 inpatients, 1.6 d decrease in LOS, at least 1 d decrease in other symptoms, this time it was 3% saline vs. NS without any bronchodilators prescribed. Only prior study to do this was Kuzik where about 30% of doses of 3% given without bronchodilators. Emergency Dept Studies Grewal S, et al. Archives Candadian ED. (n=46) Two arms, epi + NS vs. epi + HS, and up to two doses. Outcome was RACS. Everybody got better. Anil AB, et al. Ped Pulm Turkish ED. (n=186) Five arm study, albuterol and epi combined with either NS or HS vs. NS placebo give twice. 120 mins duration. Everybody got better. So why might this actually work? In vitro, HS increases airway surface thickness, decreases epithelial edema and improves mucus rheology and transport rates In vivo, HS increases mucociliary transport in normal subjects Theory of dehydration of ASL It is proposed that mucociliary failure such as occurs in CF also occurs in severe bronchiolitis due to dehydration of the ASL Airway surface liquid (ASL) is the combined mucus layer (top) and the cell surface periciliary liquid This gets dehydrated and inspissated in CF with even minor insults Mandelberg A, Amirav I. Pediatric Pulmonology 45:36-40 (2010). from Mandelberg and Amirav, modified from Randell and Donaldson What might HS do in bronchiolitis? Hydrates the ASL Breaks ionic bonds in mucus layer which reduces cross linking Increases ciliary beat frequency by release of PGE2 (note higher conc. may decrease cbf) Causes conformational change in mucus by shielding negative charges thereby reducing repulsion Theoretically reduces edema in airway wall through flow of free water into the ASL Induces cough and moves out the sputum which is now better able to flow
4 Nebulized distilled water makes a bad placebo Initial Ribavirin studies were done with distilled water as placebo, and then were not repeatable, ultimate conclusion was that the placebo was harmful whereas the medicine wasn t very useful.. NS may not be a placebo Many authors of negative studies have made this conjecture, everybody in these studies gets significantly better which makes them awfully hard to power when you are using respiratory scores as the outcome Sood N. Am J Respir Crit Care Med. 2003; 167: (proposed effects on ASL not concentration dependent but function of total NaCl delivered) Further hypothesized by both Anil and Mandelberg But is it safe? Major concern was with bronchospasm In asthma studies HS has been used to demonstrate that a patient has asthma (i.e. suffers from a repeated pattern of reversible airway obstruction) Doses are generally much higher in asthma studies (concentrations of at least 4.5% and clear dose-response curve seen with increasing volumes) From Anderson Chest - Volume 138, Issue 2 Suppl 1 (August 2010) Direct Evidence of Safety? Kuzik was the first to administer in bronchiolitis without beta-agonists but did not report clearly on this question Ralston and Hill retrospectively reported on safety profile with clear data on timing of doses of HS vs. beta-agonists Luo did a full RCT without beta-agonists Favorable safety profile for nebulized 3% in bronchiolitis is likely established
5 So what s next? Currently a multicenter study in the US at CHLA and Oakland Children s (with albuterol) Undoubtedly there will be more studies without albuterol in both the US and Canada Only in inpatients, outpatients, at home? Could you just use enough NS? No safety concerns, cheap, easy.
Bronchiolitis & Hypertonic Saline
Bronchiolitis & Hypertonic Saline Andrea Scheid MD FAAP Director, Pediatric Hospitalist Service & Medical Unit Director, Pediatric Floor Beaumont Children s Hospital, Royal Oak Assistant Professor, Oakland
More informationNebulized hypertonic saline treatment in hospitalized children with moderate to severe viral bronchiolitis
ORIGINAL ARTICLE INFECTIOUS DISEASES Nebulized hypertonic saline treatment in hospitalized children with moderate to severe viral bronchiolitis Z. Luo, Z. Fu, E. Liu, X. Xu, X. Fu, D. Peng, Y. Liu, S.
More informationNebulized Hypertonic Saline for Acute Bronchiolitis: A Systematic Review
Nebulized Hypertonic Saline for Acute Bronchiolitis: A Systematic Review Linjie Zhang, MD, PhD a, Raúl A. Mendoza-Sassi, MD, PhD a, Terry P. Klassen, MD b, Claire Wainwright, MD c BACKGROUND AND OBJECTIVE:
More informationUtility of Hypertonic Saline in the Management of Acute Bronchiolitis in Infants: A Randomised Controlled Study
Original Article Elmer Press Utility of Hypertonic Saline in the Management of Acute Bronchiolitis in Infants: A Randomised Controlled Study Sadbhavna Pandit a, Neeraj Dhawan a, b, Deepak Thakur a, b Abstract
More informationTREAMENT OF RECURRENT VIRUS-INDUCED WHEEZING IN YOUNG CHILDREN. Dr Lại Lê Hưng Respiratory Department
TREAMENT OF RECURRENT VIRUS-INDUCED WHEEZING IN YOUNG CHILDREN Dr Lại Lê Hưng Respiratory Department Literature review current through: Feb 2013. This topic last updated: Aug 14, 2012 INTRODUCTION Wheezing
More informationNebulized Hypertonic Saline for Treating Bronchiolitis in Infants A Randomised Clinical Trial Conducted In Tertiary Care Teaching Hospital
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 15, Issue 4 Ver. X (Apr. 2016), PP 99-105 www.iosrjournals.org Nebulized Hypertonic Saline for Treating
More informationWheezy? Easy Peasy! The Emergent Management of Asthma & Bronchiolitis. Maneesha Agarwal MD Assistant Professor of Pediatrics & Emergency Medicine
Wheezy? Easy Peasy! The Emergent Management of Asthma & Bronchiolitis Maneesha Agarwal MD Assistant Professor of Pediatrics & Emergency Medicine Asthma Defined National Asthma Education and Prevention
More informationNebulized Hypertonic Saline for Bronchiolitis in the Emergency Department A Randomized Clinical Trial
Research Original Investigation in the Emergency Department A Randomized Clinical Trial Todd A. Florin, MD, MSCE; Kathy N. Shaw, MD, MSCE; Marlena Kittick, MPH; Stephen Yakscoe, BA; Joseph J. Zorc, MD,
More informationPediatric Respiratory Disease: A Model for the Future of Emergency Medicine Research
Pediatric Respiratory Disease: A Model for the Future of Emergency Medicine Research Joseph J. Zorc, MD, MSCE Mark Fishman Professor, Department of Pediatrics Perelman School of Medicine, University of
More informationPAEDIATRIC RESPIRATORY FAILURE. Tang Swee Fong Department of Paediatrics University Kebangsaan Malaysia Medical Centre
PAEDIATRIC RESPIRATORY FAILURE Tang Swee Fong Department of Paediatrics University Kebangsaan Malaysia Medical Centre Outline of lecture Bronchiolitis Bronchopulmonary dysplasia Asthma ARDS Bronchiolitis
More informationA Comparative Study on Use of 3% Saline Versus 0.9% Saline Nebulization in Children with Bronchiolitis
J Nepal Health Res Counc 2014 Jan;12(26):39-43 Original Article A Comparative Study on Use of 3% Saline Versus 0.9% Saline Nebulization in Children with Bronchiolitis Ojha AR, 1 Mathema S, 1 Sah S, 1 Aryal
More informationNebulised hypertonic saline (3 %) among children with mild to moderately severe bronchiolitis - a double blind randomized controlled trial
Khanal et al. BMC Pediatrics (2015) 15:115 DOI 10.1186/s12887-015-0434-4 RESEARCH ARTICLE Open Access Nebulised hypertonic saline (3 %) among children with mild to moderately severe bronchiolitis - a double
More informationNebulized Hypertonic-Saline vs Epinephrine for Bronchiolitis: Proof of Concept Study of Cumulative Sum (CUSUM) Analysis
R E S E A R C H P A P E R Nebulized Hypertonic-Saline vs Epinephrine for Bronchiolitis: Proof of Concept Study of Cumulative Sum (CUSUM) Analysis NEERAJ GUPTA, *ASHISH PULIYEL, AYUSH MANCHANDA AND JACOB
More informationCYSTIC FIBROSIS FOUNDATION INFO-POD Information You Need to Make Benefits Decisions
CYSTIC FIBROSIS FOUNDATION INFO-POD Information You Need to Make Benefits Decisions Issue 1: Hypertonic Saline Summary: Preserving lung function is a crucial element in the care of the individual with
More informationManagement of Bronchiolitis: A Clinical Update
Prepared for your next patient. TM Management of Bronchiolitis: A Clinical Update Todd A. Florin, MD, MSCE, FAAP Assistant Professor, Department of Pediatrics University of Cincinnati College of Medicine
More informationNormal Saline vs. Hypertonic Saline Nebulization for Acute Bronchiolitis: A Randomized Clinical Trial
http:// ijp.mums.ac.ir Original Article (Pages: 8507-8516) Normal Saline vs. Hypertonic Saline Nebulization for Acute Bronchiolitis: A Randomized Clinical Trial Mohsen Reisi 1, Narges Afkande 2, Hasan
More informationVideo Cases in Pediatrics. Ran Goldman, MD BC Children s Hospital University of British
Video Cases in Pediatrics Ran Goldman, MD BC Children s Hospital University of British Columbia @Dr_R_Goldman Bronchiolitis Viral infection of the lower respiratory tract characterized by acute inflammation,
More informationRSV Bronchiolitis in Children The Bird s Eye View
RSV Bronchiolitis in Children The Bird s Eye View Nidal El-wiher, M.D. & Steve Lauer PhD MD Department of Pediatrics University of Kansas Medical Center April 19 th 2012 Case 10 mo male admitted to PICU
More informationManagement of bronchiolitis
Management of bronchiolitis Madeleine Adams Iolo Doull Abstract Bronchiolitis is the commonest cause of hospital admission in infancy. Severity varies from mild and self-limiting through to respiratory
More informationObjectives. Case Presentation. Respiratory Emergencies
Respiratory Emergencies Objectives Describe how to assess airway and breathing, including interpreting information from the PAT and ABCDEs. Differentiate between respiratory distress, respiratory failure,
More informationBronchodilators for bronchiolitis (Review)
Gadomski AM, Brower M This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2010, Issue 12 http://www.thecochranelibrary.com
More informationPediatric Bronchiolitis. Janie Robles, PharmD, AE-C Assistant Professor of Pharmacy Practice Pediatrics School of Pharmacy TTUHSC Lubbock, Texas
This PowerPoint file is a supplement to the video presentation. Some of the educational content of this program is not available solely through the PowerPoint file. Participants should use all materials
More informationSupplementary Medications during asthma attack. Prof. Dr Finn Rasmussen PhD. DrMedSc. Near East University Hospital North Cyprus
Supplementary Medications during asthma attack Prof. Dr Finn Rasmussen PhD. DrMedSc. Near East University Hospital North Cyprus Conflicts of Interest None Definition of Asthma Airway narrowing that is
More informationIntegrating Evidence-Based Pediatric Prehospital Protocols into Practice EMSC Targeted Issues Grant #H34MC19347 ASK THE QUESTION Question 1:
Integrating Evidence-Based Pediatric Prehospital Protocols into Practice EMSC Targeted Issues Grant #H34MC19347 Children with Respiratory Distress Prehospital Protocol Evidence-Based Practice Summary ASK
More informationBronchiolitis is arguably the most common
MANAGEMENT OF BRONCHÍOLITIS Focus ON HYPERTONIC SALINE BRIAN ALVERSON, MD, AND SHAWN LEIGH RALSTON, MD There is a lack of effective treatment options for bronchiolitis, the most common viral respiratory
More informationPredicting, Preventing and Managing Asthma Exacerbations. Heather Zar Department of Paediatrics & Child Health University of Cape Town South Africa
Predicting, Preventing and Managing Asthma Exacerbations Heather Zar Department of Paediatrics & Child Health University of Cape Town South Africa Asthma exacerbations Predicting exacerbation recognising
More informationStudies above were pooled with studies prior to the AAP Guideline and analyzed using GRADE (Atkins et al., 2004).
Appendix A Question 2. Updated October 2016- For the patient who presents with the symptoms of bronchiolitis should inhaled hypertonic saline be used? Literature Summary: Inpatient Length of Stay Since
More informationAcute Wheezing Emergencies: From Young to Old! Little Wheezers in the ED: Managing Acute Pediatric Asthma
Acute Wheezing Emergencies: From Young to Old! Little Wheezers in the ED: Managing Acute Pediatric Asthma Talk Outline Case Delivery of bronchodilators Meter-dose inhalers and spacers Continuous nebulization
More informationQuick Literature Searches
Quick Literature Searches National Pediatric Nighttime Curriculum Written by Leticia Shanley, MD, FAAP Institution: University of Texas Southwestern Medical Center Case 1 It s 1:00am and you have just
More informationDiagnosis and Management of Bronchiolitis
CLINICAL PRACTICE GUIDELINE Diagnosis and Management of Bronchiolitis Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of All Children Subcommittee on
More informationClinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis
Guidance for the Clinician in Rendering Pediatric Care CLINICAL PRACTICE GUIDELINE Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis abstract This guideline is a revision
More informationSeminar. Viral bronchiolitis
Viral bronchiolitis Todd A Florin, Amy C Plint, Joseph J Zorc Viral bronchiolitis is a common clinical syndrome affecting infants and young children. Concern about its associated morbidity and cost has
More informationBRONCHIOLITIS. See also the PSNZ guideline - Wheeze & Chest Infections in infants under 1 year (www.paediatrics.org.nz)
Definition What is Bronchiolitis? Assessment Management Flow Chart Admission Guidelines Investigations Management Use of Bronchodilators Other treatments Discharge Planning Bronchiolitis & Asthma References
More informationDATE: 09 December 2009 CONTEXT AND POLICY ISSUES:
TITLE: Tiotropium Compared with Ipratropium for Patients with Moderate to Severe Chronic Obstructive Pulmonary Disease: A Review of the Clinical Effectiveness DATE: 09 December 2009 CONTEXT AND POLICY
More informationAsthma Care in the Emergency Department Clinical Practice Guideline
Asthma Care in the Emergency Department Clinical Practice Guideline Inclusion: 1) Children 2 years of age or older with a prior history of wheezing, and 2) Children less than 2 years of age with likely
More informationNational Horizon Scanning Centre. Mannitol dry powder for inhalation (Bronchitol) for cystic fibrosis. April 2008
Mannitol dry powder for inhalation (Bronchitol) for cystic fibrosis April 2008 This technology summary is based on information available at the time of research and a limited literature search. It is not
More informationManagement of Bronchiolitis in Infants
Co-issued by Paediatric Medicine and the Division of Paediatric Emergency Medicine. 1.0 Introduction Bronchiolitis is an acute inflammatory disease of the lower respiratory tract, resulting from obstruction
More informationBronchiolitis v.2.0: Criteria and Respiratory Score
Bronchiolitis v.2.0: Criteria and Respiratory Score Executive Summary Test your knowledge Epidemiology, Pathophysiology & Natural History Inclusion Criteria Age
More informationNATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE 1 Guideline title SCOPE Bronchiolitis: diagnosis and management of bronchiolitis in children. 1.1 Short title Bronchiolitis in children 2 The remit The
More informationThe adult therapeutic substitution protocol follows:
Therapeutic Substitution of Albuterol - Implemented 1/15/2013 After years of evaluation, comparative studies have not consistently demonstrated clinical or safety advantages of levalbuterol over racemic
More informationAsthma Medications: Information for Children and Families. What You Need to Know about Medicines for Asthma
Page 1 of 8 PED-ALL-005-1992 Asthma Medications: Information for Children and Families What You Need to Know about Medicines for Asthma What Medicines Are used to Treat Asthma? There are two kinds of medicines:
More informationThe effect of 3% and 6% hypertonic saline in viral bronchiolitis: a randomised controlled trial
ORIGINAL ARTICLE PAEDIATRIC PULMONOLOGY The effect of 3% and 6% hypertonic saline in viral bronchiolitis: a randomised controlled trial Jasmijn Teunissen 1, Anne H.J. Hochs 1, Anja Vaessen-Verberne 2,
More informationManagement of Common Respiratory Disorders in Children. Whitney Pressler, MD Pediatric Brown Bag Series Webinar June 14, 2016
Management of Common Respiratory Disorders in Children Whitney Pressler, MD Pediatric Brown Bag Series Webinar June 14, 2016 Disclosures I have no financial relationships to disclose I will not be discussing
More informationManagement of Common Respiratory Disorders in Children. Disclosures. Roadmap 6/10/2016
Management of Common Respiratory Disorders in Children Whitney Pressler, MD Pediatric Brown Bag Series Webinar June 14, 2016 Disclosures I have no financial relationships to disclose I will not be discussing
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: bronchial_thermoplasty 10/2010 3/2018 3/2019 3/2018 Description of Procedure or Service Bronchial thermoplasty
More informationWhat is the best way to treat recurrent wheeze in pre-school children?
What is the best way to treat recurrent wheeze in pre-school children? Miles Weinberger MD Professor of Pediatrics www.uihealthcare.com/allerpulm Lower airway obstruction Asthma vs bronchiolitis? Both
More informationThe effect of 3% and 6% hypertonic saline in viral bronchiolitis: a randomised controlled trial
ERJ Express. Published on July 25, 2014 as doi: 10.1183/09031936.00159613 ORIGINAL ARTICLE IN PRESS CORRECTED PROOF The effect of 3% and 6% hypertonic saline in viral bronchiolitis: a randomised controlled
More information2/12/2015. ASTHMA & COPD The Yin &Yang. Asthma General Information. Asthma General Information
ASTHMA & COPD The Yin &Yang Arizona State Association of Physician Assistants March 6, 2015 Sedona, Arizona Randy D. Danielsen, PhD, PA-C, DFAAPA Dean & Professor A.T. Still University Asthma General Information
More informationAtrovent Administration
Atrovent Administration ICEMA Training 2007 Sherri Shimshy RN OBJECTIVES Describe the pharmacology of Atrovent Identify the indications for use of Atrovent in the Adult Population Identify the indications
More informationSIB Chart Review Tool
SIB Chart Review Tool Month/Year Chart Number (number sequentially 1-20) The first three questions are the same for BOTH the Inpatient and ED chart review tools. Inclusion Criteria Exclusion Criteria Age
More informationBronchiolitis: What s the latest evidence?
Bronchiolitis: What s the latest evidence? Leanne DePalma, MD Division of Hospital Medicine Washington University Department of Pediatrics I have no financial disclosures. 1 Goals and Objectives Goal:
More informationBronchiolitis (BRO) Overview
Bronchiolitis (BRO) Overview Common lower respiratory tract infection and leading cause of infant hospitalization Significant impact on the elderly with >220k hospitalizations per year in the US No drugs
More informationChronic Obstructive Pulmonary Disease
Page 1 of 5 Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease (COPD) is an 'umbrella' term for people with chronic bronchitis, emphysema, or both. With COPD the airflow to the
More informationApproach to Bronchiolitis
PedsCases Podcast Scripts This is a text version of a podcast from Pedscases.com on Approach to Bronchiolitis. These podcasts are designed to give medical students an overview of key topics in pediatrics.
More informationEarly Halt of a Randomized Controlled Study with 3% Hypertonic Saline in Acute Bronchiolitis
Clinical Investigations Received: October 6, 2016 Accepted after revision: May 14, 2017 Published online: June 24, 2017 Early Halt of a Randomized Controlled Study with 3% Hypertonic Saline in Acute Bronchiolitis
More informationPEDIATRIC ACUTE ASTHMA SCORE (P.A.A.S.) GUIDELINES. >97% 94% to 96% 91%-93% <90% Moderate to severe expiratory wheeze
Inclusion: Children experiencing acute asthma exacerbation 24 months to 18 years of age with a diagnosis of asthma Patients with a previous history of asthma (Consider differential diagnosis for infants
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Donaldson SH, Bennett WD, Zeman KL, et al. Mucus clearance
More informationHypertonic Saline (7%) Administration Guideline (adults)
Hypertonic Saline (7%) Administration Guideline (adults) Full Title of Guideline: Author (include email and role): Hypertonic Saline (7%) Administration Guideline for Practice (Adults) Clair Martin, Senior
More information1 Chapter 13 Respiratory Emergencies 2 Respiratory Distress Patients often complain about. Shortness of breath Symptom of many different Cause can be
1 Chapter 13 Respiratory Emergencies 2 Respiratory Distress Patients often complain about. Shortness of breath Symptom of many different Cause can be difficult to determine. Even for physician in hospital
More informationI. Subject: Continuous Aerosolization of Bronchodilators
I. Subject: Continuous Aerosolization of Bronchodilators II. Indications: A. Acute airflow obstruction in which treatment with an aerosolized bronchodilator is desired for an extended period of time, i.e.
More informationThis is the publisher s version. This version is defined in the NISO recommended practice RP
Journal Article Version This is the publisher s version. This version is defined in the NISO recommended practice RP-8-2008 http://www.niso.org/publications/rp/ Suggested Reference Chong, J., Karner, C.,
More informationEpinephrine Cardiovascular Emergencies Symposium 2018
Epinephrine Cardiovascular Emergencies Symposium 218 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN High Quality
More informationPM-03 PED ALLERGY/ANAPHYLAXIS. Protocol SECTION: PM-03 PROTOCOL TITLE: PED ALLERGY/ANAPHYLAXIS REVISED: 01MAY2018
SECTION: PROTOCOL TITLE: REVISED: 01MAY2018 BLS SPECIFIC CARE: See General Pediatric Care Protocol PM-1 - Determine patient s color category on length based resuscitation tape (Broselow Tape) Epi Pen Protocol
More informationThe Acute & Maintenance Treatment of Asthma via Aerosolized Medications
The Acute & Maintenance Treatment of Asthma via Aerosolized Medications Douglas S. Gardenhire, EdD, RRT-NPS, FAARC Associate Professor and Chairman Department of Respiratory Therapy Objectives Define Asthma.
More informationFacilitator s Guide. Prescription Writing/Patient Safety Author: Benjamin Estrada, MD, University of South Alabama. Active Learning Module
Facilitator s Guide Prescription Writing/Patient Safety Author: Benjamin Estrada, MD, University of South Alabama Active Learning Module Core Concepts In order to master this topic area, students must
More informationA silent chest is. Pediatrics II Asthma, seizures and cardiac arrest. Children are different. Cough variant asthma. Symptoms of severe distress
Asthma ~21% of all asthma cases are school aged Pediatrics II Asthma, seizures and cardiac arrest Identify 3 symptoms of an asthma exacerbation Bronchospasm Edema of the bronchi Increased mucus production
More informationInhaled Hypertonic Saline In Adults Hospitalized For Exacerbation Of Cystic Fibrosis Lung Disease: A Retrospective Study For peer review only
BMJ Open Inhaled Hypertonic Saline In Adults Hospitalized For Exacerbation Of Cystic Fibrosis Lung Disease: A Retrospective Study Journal: BMJ Open Manuscript ID: bmjopen--0000 Article Type: Research Date
More informationIs There a Treatment for BPD?
Is There a Treatment for BPD? Amir Kugelman, Pediatric Pulmonary Unit and Department of Neonatology Bnai Zion Medical Center, Rappaport Faculty of Medicine Haifa, Israel Conflict of Interest Our study
More informationRespiratory Pharmacology: Treatment of Cystic Fibrosis
Respiratory Pharmacology: Treatment of Cystic Fibrosis Dr. Tillie-Louise Hackett Department of Anesthesiology, Pharmacology and Therapeutics University of British Columbia Associate Head, Centre of Heart
More informationSTUDY ON PRESCRIBING AND ADMINISTRATION OF THERAPEUTIC AEROSOLS IN PEDIATRIC PULMONARY DISEASE AT A PRIVATE TERTIARY CARE TEACHING HOSPITAL
Page455 IJPBS Volume 3 Issue 3 JUL-SEP 2013 455-461 Research Article Pharmaceutical Sciences STUDY ON PRESCRIBING AND ADMINISTRATION OF THERAPEUTIC AEROSOLS IN PEDIATRIC PULMONARY DISEASE AT A PRIVATE
More informationElliott J. Carande, Andrew J. Pollard, and Simon B. Drysdale
Canadian Infectious Diseases and Medical Microbiology Volume 2016, Article ID 9139537, 5 pages http://dx.doi.org/10.1155/2016/9139537 Research Article Management of Respiratory Syncytial Virus Bronchiolitis:
More information4.6 Small airways disease
4.6 Small airways disease Author: Jean-Marc Fellrath 1. INTRODUCTION Small airways are defined as any non alveolated and noncartilaginous airway that has an internal diameter of 2 mm. Several observations
More informationASTHMA. Epidemiology. Pathophysiology. Diagnosis. IAP UG Teaching slides
BRONCHIAL ASTHMA ASTHMA Epidemiology Pathophysiology Diagnosis 2 CHILDHOOD ASTHMA Childhood bronchial asthma is characterized by Airway obstruction which is reversible Airway inflammation Airway hyper
More informationRespiratory infection what works Professor Terence Stephenson President Royal College of Paediatrics & Child Health
Respiratory infection what works Professor Terence Stephenson President Royal College of Paediatrics & Child Health Nuffield Professor, Institute of Child Health, University College London & Great Ormond
More informationCOPD: A Renewed Focus. Disclosures
COPD: A Renewed Focus Heath Latham, MD Assistant Professor Division of Pulmonary and Critical Care Medicine Disclosures No Business Interests No Consulting No Speakers Bureau No Off Label Use to Discuss
More informationMCQ Course in Pediatrics Al Yamamah Hospital June Dr M A Maleque Molla, FRCP, FRCPCH
MCQ Course in Pediatrics Al Yamamah Hospital 10-11 June Dr M A Maleque Molla, FRCP, FRCPCH Q1. Following statements are true in the steps of evidence based medicine except ; a) Convert the need for information
More information10/6/2014. Tommy s Story: An Overview of Asthma Mangement. Disclosure. Objectives for this talk.
Tommy s Story: An Overview of Asthma Mangement Clifton C. Lee, MD, FAAP, FHM Associate Professor of Pediatrics Chief, Pediatric Hospital Medicine Children s Hospital of Richmond at VCU Disclosure Obviously,
More informationChronic Obstructive Pulmonary Disease (COPD) KAREN ALLEN MD PULMONARY & CRITICAL CARE MEDICINE VA HOSPITAL OKC / OUHSC
Chronic Obstructive Pulmonary Disease (COPD) KAREN ALLEN MD PULMONARY & CRITICAL CARE MEDICINE VA HOSPITAL OKC / OUHSC I have no financial disclosures Definition COPD is a preventable and treatable disease
More informationMAYA RAMAGOPAL M.D. DIVISION OF PULMONOLOGY & CYSTIC FIBROSIS CENTER
MAYA RAMAGOPAL M.D. DIVISION OF PULMONOLOGY & CYSTIC FIBROSIS CENTER 16 year old female with h/o moderate persistent asthma presents to the ED after 6 hours of difficulty breathing, cough, and wheezing
More informationPEDIATRIC RESPIRATORY ILLNESS MADE SIMPLE
Copyright 2012 Joel Berezow, MD and The Pediatrics for Emergency Physicians Network All rights reserved. Duplication in whole or in part, or electronic transmission in any form, is prohibited THE PEDIATRICS
More informationThe Effectiveness of Dexamethasone as Adjunctive Therapy to Racemic Epinephrine for a Pediatric Patient With Bronchiolitis
Pacific University CommonKnowledge School of Physician Assistant Studies Theses, Dissertations and Capstone Projects 8-14-2010 The Effectiveness of Dexamethasone as Adjunctive Therapy to Racemic Epinephrine
More informationRespiratory Anesthetic Emergencies in Oral and Maxillofacial Surgery. By: Lillian Han
Respiratory Anesthetic Emergencies in Oral and Maxillofacial Surgery By: Lillian Han Background: Respiratory anesthetic emergencies are the most common complications during the administration of anesthesia
More informationChildren s Mercy Hospitals and Clinics Evidence Based Practice Clinical Practice Guide
Children s Mercy Hospitals and Clinics Evidence Based Practice Clinical Practice Guide Outpatient Bronchiolitis 2013 1 Inpatient 2 Epidemiology: Bronchiolitis is the most common lower respiratory tract
More informationEpiglottitis. Bronchitis. Bronchiolitis. Pneumonia. Croup syndrome. Miss. kamlah 2
Miss. kamlah 1 Epiglottitis. Bronchitis. Bronchiolitis. Pneumonia. Croup syndrome. Miss. kamlah 2 Acute Epiglottitis Is an infection of the epiglottis, the long narrow structure that closes off the glottis
More informationDiscuss the benefits for developing an outpatient bronchiolitis clinic.
Diana L Mark, RRT Pediatric Clinical Specialist Respiratory Care Wesley Medical Center Discuss the benefits for developing an outpatient bronchiolitis clinic. 1 Definition Inflammation of the bronchioles
More informationOverview of COPD INTRODUCTION
Overview of COPD INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a common lung disease that affects millions of people, and it is the fourth leading cause of death in the United States. It
More informationExercise and Asthma: What patients and doctors can do to improve outcomes
Exercise and Asthma: What patients and doctors can do to improve outcomes Timothy Craig, DO Professor of Medicine and Pediatrics Distinguished Educator Program Director Penn State University Hershey, PA,
More informationNebulised hypertonic saline for cystic fibrosis.
Revista: Cochrane Database Syst Rev. 2003;(1):CD001506. Nebulised hypertonic saline for cystic fibrosis. Autor: Wark PA, McDonald V. Source: Department of Respiratory Medicine, John Hunter Hospital, Locked
More informationCYSTIC FIBROSIS INPATIENT PROTOCOL PURPOSE POLICY STATEMENTS SITE APPLICABILITY PRACTICE LEVEL/COMPETENCIES DEFINITIONS EQUIPMENT
PURPOSE Physiotherapy role for inpatients with cystic fibrosis. POLICY STATEMENTS On admission to hospital all patients will be assessed by the physiotherapist within 24 hours. Physiotherapists have standing
More informationDual-Controller Asthma Therapy: Rationale and Clinical Benefits
B/1 Dual-Controller Asthma Therapy: Rationale and Clinical Benefits MODULE B The 1997 National Heart, Lung, and Blood Institute (NHLBI) Expert Panel guidelines on asthma management recommend a 4-step approach
More informationOBSERVATION UNIT ASTHMA PATHWAY OUTLINE Westmoreland Hospital PAGE 1 OF 5
PAGE 1 OF 5 Exclusion Criteria: (Reason to admit to hospital) A. New EKG changes except sinus tachycardia B. Respiratory Rate > 40 C. Signs/symptoms of Heart Failure D. Impending respiratory failure or
More informationAsthma is global health problem in children,
Paediatrica Indonesiana VOLUME 52 July NUMBER 4 Original Article Efficacy of salbutamol-ipratropium bromide nebulization compared to salbutamol alone in children with mild to moderate asthma attacks Matahari
More informationChronic obstructive pulmonary disease
Chronic obstructive pulmonary disease By: Dr. Fatima Makee AL-Hakak () University of kerbala College of nursing Out lines What is the? Overview Causes of Symptoms of What's the difference between and asthma?
More informationADASUVE (LOXAPINE) INHALATION POWDER. EDUCATION PROGRAM for HEALTHCARE PROFESSIONALS
ADASUVE (LOXAPINE) INHALATION POWDER EDUCATION PROGRAM for HEALTHCARE PROFESSIONALS August2017 December 2012 PMR-JUN-2017-0017 ADASUVE Risk Evaluation and Mitigation Strategy (REMS) Education Program Content
More informationBronchiolitis: Systematic Review with 3 Decades of Experience in Resource-limited Setting
Cronicon OPEN ACCESS EC PAEDIATRICS Review Article Bronchiolitis: Systematic Review with 3 Decades of Experience in Resource-limited Setting Suraj Gupte* Professor and Head, Postgraduate Department of
More informationAsthma and COPD in the ICU
Asthma and COPD in the ICU Prescott Woodruff, MD, MPH Assistant Professor Medicine in Residence Pulmonary and Critical Care Medicine, Department of Medicine Acute Exacerbations of Asthma Asthma exacerbations
More informationDear Reader, What was the study about? Why was the research needed? BI NCT
Dear Reader, Sponsors of clinical studies create study reports. A study report describes how the study was done and what the results of the study were. This is a summary of such a report. It is meant for
More informationSession: 4819 Q & A Workshop Respiratory Allergies
Section Of Allergy/Immunology American Academy of Pediatrics Session: 4819 Q & A Workshop Respiratory Allergies Chitra Dinakar, M.D., F.A.A.P. Professor of Pediatrics University of Missouri-Kansas City
More informationDAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES
DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES DISCLAIMER: This Clinical Practice Guideline (CPG) generally describes a recommended course of treatment for patients with the identified health
More information