The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

COMPARING THE USE OF A HIGH CONCENTRATION AEROSOL DELIVERY (HCAD) WITH A CIRCULAIRE? VERSUS CONVENTIONAL SMALL VOLUME NEBULIZER FOR ADMINISTERING ALBUTEROL IN THE EMERGENCY DEPARTMENT USING A RAPID-SEQUENCE PROTOCOL

Gus Doescher, RPFT-RRT, Mission-St. Joseph's Health System, Asheville, NC

Background: Our facility currently uses a rapid-sequence, patient-driven protocol for the administration of beta-agonist bronchodilators (albuterol) to treat dyspneic patients presenting with acute bronchospasms in the emergency department. Skolnick et al1 had previously reported success with timed, high concentration aerosols using the Circulaire? (WestMed, Inc., Tucson AZ), but only for intermittent use. Mason and Miller2 had utilized the device in a rapid-sequence method, but not with high concentration. As a potential process improvement, our facility chose to combine these two ideas and investigate the efficiency and efficacy of a rapid-sequence, HCAD protocol with 1 cc undiluted 5 mg/ml albuterol, versus our current method of therapy utilizing a MistyNeb (Allegiance Healthcare Corporation, McGaw Park, IL) and standard unit dose albuterol.

Method: We drafted a policy and procedure patterned after our existing emergency department protocol incorporating HCAD. Using a randomized method, we focused on two areas: patient outcomes and efficient use of hospital resources. Patients meeting criteria for beta-agonist therapy would be treated under our previous protocol, or under the HCAD protocol. The data collection and documentation took place in addition to our regular charting on a data collection tool developed specifically for the study. For patient outcomes, we monitored pre and post-treatment heart rate, peak expiratory flow rates, and whether or not the protocol had to be repeated. For monitoring efficiency, we examined total treatments required, total treatment time, and admission rates to the hospital.

Results:
In the course of the study 49 patients were examined. The average change in heart rate was 10.75 beats per minute (bpm) for the Circulaire and 10.8 bpm for the small volume nebulizer. Average change in peak flow rate data between the two methods was within 2% of each other. A similar finding was noted with respect to hospital admission rates among the two groups. The average total length of treatment per completed protocol was 19.6 minutes for the Circulaire versus 37 minutes for the small volume nebulizer.

Conclusions:
In examining patient response to therapy, both methods appear equivocal, neither method distinguishing itself significantly from the other in this respect. However, the Circulaire and HCAD did out-perform the MistyNeb by reducing the total treatment time slightly more than a quarter hour per protocol. Our data suggests that the Circulaire using a rapid-sequence HCAD protocol is an equivalent therapy modality to conventional methods, and offers a potential improvement in efficient use of hospital resources and personnel.
1 Skolnick JL, Beach WJ, Garcia R, Holeman L. The Safety and Efficacy of Rapid, High Concentration Nebulization of Beta Agonist Bronchodilator. Chest 1977; 112 (3S) p. 11.
2 Mason JW, Miller WC. Abbreviated Aerosol Therapy for Improved Efficiency. Journal of Aerosol Medicine 1998 Fall; 11(3) p. 127-31.

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