Comparison between direct humidification and nebulization
Comparison between direct humidification and nebulization
This article found in the journal of nursing is aimed at studying the effectiveness of nebulization compared to direct humidification process of the respiratory tract at the mechanical process of ventilation. It is based on a study carried out on nine patients and the comparison is based on the distribution of an instilled radiolabelled saline solution and an inhaled nebulized radiolabelled saline. The technique that was used was the scintigraphic technique. The main reason why the author carried out the study was to study the effects if any of using instillation of physiological saline solution before suctioning as a way to soften the mucus and hence facilitate the removal of the secretions. But she had doubts that such instillation may not increase the yield at subsequent suctionings. She was also concerned about the adverse effects that the saline solution instillation could have on an individual like the flushing of materials of the respiratory tract from the upper regions to the lower regions which could increase the risk for pneumonia not to mention that the saline instillation may decrease oxygen concentration after suctioning. The author's main point was to justify the use of nebulization process compared to direct instillation arguing that with nebulization, the fluid is well distributed between and within the lungs and is less influenced by gravitation unlike in direct instillation where the fluid goes to the right posterior portion of the right lower pulmonary lobe and it is influenced by gravitation. Also the article points out that with nebulization, the aerosols reach the periphery of the lungs to a larger extent.
This article is intended for respiratory therapists and nurses involved in the suctioning procedure of the patients. Its aim was to prove to this audience that nebulization process was better compared to direct instillation. The study came about due to a survey that had been carried out and that showed that 33% of the nurses and respiratory therapists use instillation of saline frequently.
The author argues that nebulization process is better compared to the routinely used 2ml of saline for instillation in the endotracheal tube before suctioning. This, he argues is because the inhalation of nebulized fluid may give rise to a different and more uniform distribution of the fluid and hence allow the delivery of large volumes. That is the author carried this study to compare the distribution of instilled saline solution to the distribution of inhaled nebulized solution.
The article is well presented with the methods used to carry out the study well documented. The nine patients who participated in the study were well chosen because their mean age was 65 years, the years where most respiratory problems occur. The only limitation was the use of six males and three females. For accurate and unbiased results, the author would have used equal numbers of males and females for the study. The investigation design was well carried out with five patients being examined after direct instillation followed by another examination after nebulization with the other four patients following the opposite order. In the end there were no systematic differences between the two groups. Also the use of dynamic imaging made the study possible. Though the article is well organized, it has used a lot of medic jargon that only the doctors, nursing fraternity and the nursing students can understand. But since the article is targeting them, we can say the article fits its prescribed audience.
The authors facts can be said to be accurate based on the methods he used and how he carried out the analysis. the author has based the results and facts of the study on the activity distribution of the instilled saline solution by direct humidification and by nebulization in the respiratory tract. The comparison of the two techniques was made by evaluating the difference between the median percentage activity of the VOI. She used the Wilcoxon signed rank test and a P-level < 0-05 was considered significant. For the lower analysis, her author used a paired t-test with a 0-05 two sided significance. Even though, the accuracy can nit be said to be conclusive because the number of patients studied was very small and there was a large variation between the subjects. The results of the study had a very large type 2 error .the author justifies the results of the study with a claim that due to the fact that it required substantial effort and due to practical reasons, it was not possible to have a large sample for the study. She goes on to recommend a replication of the study using a larger sample.
Most of the important terms have not been clearly defined. This may be due to the fact that the target audience may be conversant with most of these terms and hence the author saw no need of clearly defining these terms.
The argument that the author puts forward is logical though more study needs to be carried out on the same using a larger more representative sample. Even though there are studies that have been carried out that reports a positive effect of direct instillation of the saline in the respiratory tract. But also it has been shown that even mixing physiological saline in vitro within respiratory mucous does not make it less viscous. The article supports the main theme even with all the limitation of the study. The results in the article of the study carried out shows that nebulization is a better technique compared to direct humidification and the study carried out the comparison to prove this. The article is appropriate for the intended audience who may now carry out more study on the same or they may shift from using the direct humidification to nebulization. The article has clearly presented opposing views from studies which show that direct instillation is infact beneficial but it has also refuted this based on the facts of the study. The words that evoke a strong response from me is the claim that non-bronchoscopic direct instillation of saline should not be used with mechanical ventilation. This should not be so conclusive given that comprehensive study has not been carried out. The author should let more studies to be carried out before she comes up with such a conclusive statement.
The author makes me think that the use of direct humidification process should be done away with and that nurses and respiratory therapist should shift to nebulization. Tour Operators in India Describes The Tour to Ladakh Holiday in Istanbul Explore Pilgrimage And Spirituality: Buddhist Pilgrimage Tours In India Take India Wildlife Tours To Become One With Nature Amazing TV Technology - Liquid crystal display Vs LED Comparison with 3D Made Simple Choosing Between Strollers and Baby Travel Systems Australian Domain Names - Cheapest Domain Names New York Holiday Ensures an Unforgettable Experience Spring Time - time to spend in the garden Choosing a pest control company in London A Guide To Summer Tops Know Your Travel Money Possibilities Smart Menswear For Summer