Nebulizer and nebulizer therapy. Nebulizer therapy in complex treatment of respiratory infections

"PRACTICE of pediatrics"; spring; 2013; pp. 46-51.

N.G. Kolosova, Ph.D. M.N., Associate Professor of the Department of Children's Ailments of the First Moscow State Medical University ім. I.M. Sechenov

Ingestion therapy є shortening both in children and in older adults for the treatment of severe chronic and recurrent respiratory tract infections, such as obstructive bronchitis, bronchial mucosal asthma, laryngotracheitis,

For the delivery of drugs in vicoristovoyt іnіngalаtsіynі attachments, such as dosed aerosol inhalators, powdered inhalators, nebulizers. For many children and older adults, it is difficult to see the recommendations for victorious inhalers. The pardons at the Victory of England lead to the wrong time lykarskoy speech v cheerleaders, Non-primed improvement of the treatment, the increase in the number of side effects and foreign therapy variability.

Nebulizer is the most effective way of delivery to pediatric practice. A nebulizer (in Latin Nebula - fog) is an attachment for cutting drug preparations and delivery to dichally the male part of the nebulizer is based on the initial main characteristics) and of the generating part of the size of the small diameter (2-8 microns). The amount of the drug, which should go to the wicked way, lie in the first place in the size of the particles, so that the drug becomes suitable for the drug (Fig. 1).

Malunok 1

Rozpodil part of aerosol in the respiratory tract

The stagnation of nebulizers is more beautiful in children (just as a matter of fact), since they cannot create an adequate English maneuver, but naturally, it is natural to make them quicker in terms of delivery. Nebulizer therapy can be used in hospitals, as well as in home minds, by daddies, and is especially effective for children. early vik... In addition, the transfer of nebulizer therapy є the possibility of delivering a large dose of the drug and eliminating the effect for a longer short period of time, the technique of carrying out the inhalation is simple, including in home minds. With the aid of a nebulizer, you can use a wide range of medicines (you can use all the standard solutions for ingestion) and combinations (you can use two or more medicines for one hour). Nebulizer - adin for delivery lykarsky drug in the alveoli. If necessary, it is possible to connect it to the supply circuit or to connect it to the LWL circuit.

In this hour, compressor, ultrasound and Mesh-nebulizers are widely used.

The ultrasonic nebulizer generates aerosol by means of vibrating a n'zoelectric crystal, as a result of which the ultrasonic chill produces a heterodispersed primary aerosol over the surface of the ridin. When the larger particles are seen, only the respirable parts are inhaled by the patient through the mouthpiece. The crushing of aerosol parcels is driven by a path of growth in frequency and the vibration of a n'zoelectric crystal. Inhaled raschin heats up in the course of nebulization, which can lead to a change of power by abusing the drug. Also, before the shortage of ultrasonic nebulizers, it is possible to introduce ineffectiveness in aerosol production with suspensions and viscous solutions.

At the compressor nebulizer there is a tendency to squeezed twist, to pass through the vuz'ky opening, opening a negative vice (Ventura principle), and to bring into its own power until absorbed the ridini through special channels in the nebulizer system. The viscous fluidity of the flowing stream interferes with the origin and shape of the part of the so-called "primordially generated aerosol". As a result, a “secondary” aerosol is established - ultrafine particles with a size of 0.5-10 microns (close to 0.5% of the primary aerosol). Secondary aerosol is inhaled, and big part particles of the primary aerosol (99.5%) are deposited on the inner walls of the nebulizer chamber and are once again drawn into the process of developing aerosol.

Membrane nebulizers (mesh-effect) have combined ultrasonic and jet nebulizers. The vibrations of the electronically initiated piezo ring are transmitted to a thin metal membrane, and periodic fluctuations are formed, and the angular opening through the micro-opening is clearly formed. Smell, like і extraordinary ultrasound nebulizers, compact and noiseless when robotic, albeit, on the other hand, the frequency of ultrasound may be reduced by the frequency of ultrasound, so that it is possible to vikoristvuyu in the nebulizer mesh to use the anti-drug, which Mesh nebulizers are also characterized by the lowest surplus volume; likarski zasobi.

Obsyag age, recommendations for cutting, in the majority of nebulizers to become 3-5 ml, if necessary, it is necessary to add physiological breakdown to the drug to reach the drug. It doesn’t go to waste for food and mineral water. For nebulizer therapy, you can use anti-inflammatory drugs: anti-bronchodilators (salbutamol, ipratropium bromide and in.), Anti-inflammatory drugs (glucocorticoids, other drugs), іnshі lіkarskі zasobi. The amount of drug drugs allowed, if necessary, immediately indicate a number of drug users, when the hour of preparation and the triviality of the drug is changed (table)

Table

The complexity of medicines for nebulizer therapy

Slide of addiction, which cannot be used for ingestion of the drug, not intended for nebulizer therapy: all solutions, including oils, suspensions, and solutions, as well as herbal parts, including those for papilla, і їм ім ібні mind, do not miss the points of application on the mucous shells of the dykhalnyh nobles. The fluidity of the feed should be 6-10 l / min, the triviality of the ingestion is 5-10 min.

In this day, the treatment of vikorisation is not only for bronchogenic pathology, but also for the treatment of stenotic laryngotracheitis and other ENT diseases.

State Respiratory Disorders (GRZ) є naybilsh often pathological childish vik In connection with which the nutrition of rational and successful therapy of this pathology becomes relevant. GRZ є Inappropriate therapy of GDH can lead to a prolonged interruption of the disease and the development of an accelerated rate, as well as the increase in the number of strains of antibacterial drugs that are resistant to traditionally vicious antibacterial drugs. The most high level of illness is associated with children from 3 to 14 years in the cold season of rock and can have the character of epidemias, especially in childish groups. For children of preschool age, sickness at the GRZ can be attributed to a stretch of rock, with an increase in frequency in the main winter and spring months.

In addition, repeated respiratory illness can cause the formation of chronic pathology of mental health, change the reactivity of the body, sensitize him, reduce and reduce the muscle tissue and immune system. The development of chronic respiratory ailments in the order of the parts of the GDH in the first place and in the inefficient way

One of the most widespread manifestations of respiratory infections is rhinosinusitis - inflammation of the mucous membrane of the nose and the paranasal sinuses (often the upper slit). Vipit in the sinuses, because of the tightening of the mucous membrane, appears in the presence of pre-existing epididymal sinuses on the 1st stage of GDVI in 70% of the cases, and after 10-15 days, it mimically becomes apparent, and antibiotics and phytosis are not needed. In the development of severe sinusitis, the main role is played by S. pneumoniae and H. influenzae, and in ailments, who have rejected antibiotics, it is possible to develop stiky forms of cich Zbudniki, as well as M. catarrhalis. Gn_yny sinusitis starts to wick up staphylococci, and more - pneumococci.

Antibacterial therapy is indicated for damaged nasal dysfunctions from lacrimal visions lasting 10-14 days from the ear of illness, sparing radiological (or ultrasonic) changes in the sinuses, blood clots of the posterior leucocytosis

Unimportant to the magnificent arsenal of lykarsky assists, therapy respiratory infections do not expect to pass successfully. As a rule, the reasons for this are unfortunate and inadequate ethiotropic treatment. In the most important cases, the politicians are informed of the recognition of children as "intuitive", so as the introduction about the etiology of the GRZ is very similar key manifestations vіrusnykh i bacterial infections in the early stages of becoming ill, it is very difficult to sub'actively and lie down as a special drug. For the skin localization of the bacterial process, there is no doubt that there are not many diseases of the disease, which allows the development of a rational vibration of antibiotics for starting therapy and the substitution for the reason of ineffectiveness.

Non-primed signs of systemic antibiotics to produce rhizicum before admission side effects, Destruction of microbial biocenosis and expansion likarsky style... Moreover, with gostromu Respiratory ailments of the upper spirits of systemic antibiotics do not develop bacterial superinfections and can help them develop through the suppressed normal flora of spirits. The current antibacterial therapy is very fast, the incidence of illness and the decrease in the severity of the symptomatology, not to systemic antibiotics. Of great importance in pediatrics is also the presence of systemic side reactions with the ingestion of antibiotics.

The main factors of rational antibiotic therapy are independent of the severity and localization ignition processє:

Antibacterial drugs for muscular dyes are included in the new standards and recommendations for the therapy of rhinosinusitis, which, in addition to antibacterial therapy, includes the preservation of mucolytic drugs. On the current day, there is only one drug that should be included in the standard therapy for rhinosinusitis and is a combination of antibiotics thiamphenicol and mucolytics of direct N-acetylcysteine, - the whole drug Fluimucyl-antibiotic. (Fig. 2). Tіamfenіkol Mensch activity nіzh deyakі zahischenі penіtsilіni at vplivu on Streptococcus pneumoniae, ale activity vіdnosno bagatoh shtamіv, stіykih to beta-lactam antibіotikіv, vnutrіshnoklіtinnih zbudnikіv (Legionella, Chlamidia Mycoplasma), shtamіv Staphylococcus aureus, zavdyaki chomu vіn Mauger vikoristovuvatisya in yakostі antibіotika pershit vibration in the therapy of respiratory infections. N-acetylcysteine ​​has a direct mucolytic effect on the pathological secret for the breakdown of disulfide links in glucoprotein slides, which significantly reduces the viscosity of the secret; as well as a protective effect on cells of the cellular diet, anti-firing and antioxidant activity. In addition, the anti-adhesive effect of N-acetylcysteine ​​will benefit from the antibacterial activity of thiamphenicol. The drug Fluimucyl-antibiotic IT is consumed muscularly and is allowed to settle down as a systemic antibacterial drug.

baby 2
Therapy of bacterial rhinosinusitis according to the standards of therapy includes:

In case of treatment of rhinitis, sinusitis and rhinosinusitis (both bacterial and allergic), the therapy is already important and effective, because it is only possible to deliver a combination of speech in the middle side-by-side... For the elimination of sickness of the upper dichny paths with the vikoryannya of drugs in the aerosol form, compressor nebulizers with the pulsating and uninterrupted supply of aerosols (every 8 to 10 microns) can be used. Іngalyatsії trivayut not more than 10 quills and can be repeated up to 3 times a day.

It has been shown that the drug Fluimucyl-antibiotic IT with aerosol injection (500 mg) reaches maximum plasma concentrations, the concentration of the drug is not too much, but it is administered orally, there is a low level of protein-protein and viscous into the mucous membrane of the respiratory tract. In a given hour, the drug Fluimucil-antibiotic IT є Edinim combined drug, Scho є have been introduced for the aerosol way. Preliminary studies have shown that the treatment of rhinosinusitis due to the help of the ingestion of the drug allows rapid presentation of the reaction that is adequate to the nasal reaction, and also the speed, and also the speediness of the unique invasive methods, giving such a diagnosis To ensure accurate delivery of the drug in the place of inflammation of the inhalation therapy, it allows the irritation of the mucous membrane of the nose and nasal sinuses, accelerate the regeneration of the nasal epithelium, polypsychitis of the mucociliary.

Fluimucyl-antibiotic IT permissions for introduction into additional sinuses nose, drum abo pislyaoperatsіynu empty(pislya surgical engagement on the nipple-like outgrowth) without bristles. In foreign literature and data on the possibility of stagnation and efficacy of the drug in exudative otitis media and pharyngotonitis in children (Serra, Aeb. Al., 2007).

In case of inhalational treatment of gastrointestinal rhinosinusitis in children for the supplementary Fluimucyl-antibiotic IT, a dose of 250 mg two to one per day is sufficient, including for the depot depot in the cavity. When taking the drug, you will soon need to receive systemic antibiotics and puncturing the maxillary sinuses (in the case of ch. I repeated) and even up to the 3rd (and then more than 7th) day, as soon as the ear is taken, it is effective in the main Conducted follow-ups also demonstrated the safety and low incidence of side effects during victorian given to the drug(Fig. 3).

baby 3
Efficiency and safety of TGA
Multicenter care: 475 older adults and 112 children with respiratory infections, where mucostasis is supervised

In such a rank, misce introduction the drug, indicated before zasosuvannya - lykuvannya rhinosinusitis, gnіynykh otitіv and the low frequency of side effects allows the use of the drug Fluimucil-antibiotic IT as an alternative to systemic antibacterial drugs for the treatment of bacterial respiratory infections in children.

Fluimucyl-antibiotic IT - single complex preparation for the ingestion of antibiotics wide range thiamphenicol.

The list of literature is in the editorial office.

For the data of the VOOZ, at the state republican respirator Infectious diseases shorіchno ailing skinny third inhabitant of the planet. In children up to 3 years old, the stench becomes 65% of the stench. In a group of often sick children, 25% of the child population has a seizure, and the frequency becomes 4-12 and more times per day. Anxiety of organs of dichotomy (ZOD) is the most frequent pathology of a child's life, which can be explained by some of the main reasons: strain on the immune system of an actively growing organism, anatomophysiological features dichotomous systemsі її by a high schism penetrated by microbes. The mucous membrane of the respiratory tract is constantly aware of the negative influences of the developmental factors of the new middle and this area, the young minds can adhere to pathogenic microorganisms, and reproduce, with a further increase.
Consistent success in the treatment of ZOD in children є not only the correct choice of medications in the dosage regimen, but also the way of delivery of the drugs to the legacy.
On a current day in the world, the most optimal for the treatment of children with health conditions are the methods of delivery of likars' supplies, so it is logical to do so, as if there are too many people to drink in the middle of the day. Aerosol is used for delivery to the bronchi of bronchodilators, mucolytics, anti-tartar drugs, Ingredients of glucocorticosteroids, antibiotics and other drugs.
English therapy of a house for a long time in China, Egypt, India: the first description is given in the texts of Ayurveda more than 4000 years ago. In the ancestors of Hippocrates and Galen, you can know the clues about the ingestion of fragrant dims of roselin. Aerosol (from the Greek. Aero - povitrya and Latin Solucio - rozchin) - dispersed systems, which are stored from the gas middle, in such hard or small particles. In nature, there are natural aerosols - some seaside resorts, phytoncidi and patience, vidiluvani dews. In medical cases, it is more common to use individual aerosols, which can be recognized as a supplementary source of dispersive sums in a medium or solid phase.
International programs start the key factors for the success of the therapy:

• the manifestation of an effective and infinite drug substance
• pristіy for іngalyatsії, which will preserve a high respirable fraction of the drug
• correct technique

Nebulizer therapy breakthroughs:

The basic principle of the treatment of infectious diseases of ENT organs from the intake of nebulizer therapy

sinusitis.
Prior to them, ignition processes occur in the nasal sinuses (upper slit, frontal, ethmoid, basic), which develop when the function of the osteomeatal complex is impaired. Likuvannya, as a rule, is more conservative. Antibiotics of a wide range of diets are meant, vascular dots in nis, drugs, and mucociliary cleansing for supplemental inhalation therapy (0.9% NaCl, 2% Na hydrocarbonate, rinofluvanucyl). We will stay for an hour in the complex therapy of sinusitis, all the more often to get rid of topical corticosteroids (phlexonase, nasonex).

adenoids.
Tse zapalennya hypertrophic nasopharyngeal migdale, mainly in children. The combination of LZ in viglyadi nasal sprays (Polydexa z fenilephrine, Izofra and I. An important place in the treatment of adenoiditis is the use of inhalation therapy through a nebulizer - folding inhalation with furacilin through nis, 2% Na hydrocarbonate, dioxidine, miramistin, iodinol.

pharyngitis.
The treatment of the hospitable pharyngitis includes the sign of warm, non-irritating ryzhi, nebulizer ingestion of antiseptics, 2% sodium bicarbonate, 0.9% NaCl, phytopreparations of antiseptic diy (rotokan 1:50, puddles) ... It is widely used for antiseptics of empty mouth and throat (antiangin, septolet, decatilen, іngalіpt and іn.).

laryngitis.
During the development of a state-of-the-art ignition process in the larynx, a viscous, gentle voice mode lasting 5-7 days, warm pitty, nebulizer ingalatization (s Mucolytics, 0.9% NaCl, 2% Na bicarbonate, suspension hydrocortisone, phytoplasmic acid , chamomile, mati-y-machuha, thyme and ін.)). There is also a stagnation of miscellaneous antibiotic therapy with Bioparox, physiotherapy for the larynx region (ultrasound, magneto therapy, phonophoresis LZ), voluntary therapy. Important types of antibiotics have a wide range of antibiotics.

Gostry stenotic laryngotracheitis (malfunctioning croup).
It develops more often among children of the preschool age for the heating and filling of the bed in the subfold area. At the same time, stenosis of the larynx develops during the growth stage of the turn. In this vypadka the terms of the hospital are shown. On the cob stage of therapy for the ingestion of adrenaline, glucocorticoids, furosemide through a compressor nebulizer, parenteral administration of glucocorticosteroids, furosemide, antibiotics is shown in important vials.

With a therapeutic method behind the aid of a nebulizer, there is a possibility of vicarious treatment of small groups of drugs. Tse takі zasobi:
develop a nasal secret;
mucolytics;
M-holinolitics, who accept the reduced secrets of promoted products;
cromoney;
antiapalny drugs;
antibacterials.

Preparations for developing nasal secretions

You can see 4 main directions for storing NT in pediatrics:

• Broncholic therapy - in case of aggravated BA and in the case of other variants of gastrointestinal bronchial obstruction.
• Mucolytic therapy - bronchitis, pneumonia, cystic fibrosis.
• Protisapal therapy - inhalation glucocorticoids for broncho-obstructive syndrome, Stenosis of the larynx.
• Antibacterial therapy.

The availability of nebulizers in children with broncho-obstructive ailments should indicate the high efficiency of this method of delivery of the drug. So, when evaluating the ingestion therapy in children of young children, it was determined that the need for a nebulizer to reach the end of the day quickly took the advantage of self-respect, change, and in some of the ailments, I bought the disease. Vikoristannya nebulizer allowed in a large number of cases in the form of infusion therapy. The stagnation of the nebulizer to produce a greater degree of bronchodilator function is important in the case of other bronchial tubes in the case of regular doses of inhalers, so that it will surely be shown to be dynamic. With a wide range of NT, there is a safe and manual way of delivering drugs, especially in small children.
In such a rank, nebulizer therapy in a given hour is the most important place in the life of children and adults. The price is tied to the optimal possibility of delivery of the necessary medications without the need for a middle way, so that there is a greater therapeutic effect, with a quick reduction in symptoms and changes in the severity of an illness. Adequate nebulizer therapy and implementation in the widespread work of stationary and outpatient facilities, as well as in the practice of shvidkoy medical aid, Allow to reduce the frequency of hospitalizations, and in cases of infusion and systemic therapy.

Nebulizer therapy in the practice of a therapist

PEROLIK IS SHOROCHEN

AB - antibiotic (antibiotic)

BA - bronchial asthma.

KGS - glucocorticoids

DAI - dosage aerosol inhaler.

SHVL - piece ventilation lungs.

ІГКС - іngalyatsіynі glucocorticoids

UAC - zagalny analiz blood

OB - gostry bronchit

OFV 1 - volume of forced output for 1 s.

PSV - PIKOVA SHVIDKIST VIDIKH.

FBS - fibrobronchoscopy

COPD is a chronic obstructive ailment disease.

Entry. What about a nebulizer?

The term Nebulizer, nebulizer therapy has literally passed into the Russian medical literature and lexicon has been recently developed in the first rock of the world. So well tse take - a new straightforward in medicine with modern technologies, Is there a change of terminology or information about what has passed since the release of specific recommendations?

The term "Ingalyatsiyna therapy" is a sign of skin medicine for students. Head of the English delivery method for everything, like a house or a zerosum - Dissolve the maximum therapeutic concentration of the drug in the dormant paths with the minimum concentration in the bloodstream, and apparently not to the active metabolism and inactivation.

There are a large number of pharmacies in memory of medical facilities or inhalators in pharmacies and sanatoriums, without baked steamers inhalers with compressors. However, the set of therapeutic drugs, which can be used in such inhalers, is small through high temperature the difference, in addition, the size of the parts of such aerosol did not allow talking about their delivery to other and middle bronchi. Silent ultrasound appeared in the year іngalyators with a high degree of dispersion, the stench doesn’t need to be applied until the suspension is powdered, and the microelement must be heated up to a significant heating, but at once with the injection of ultrasound, a number of drugs are activated. In addition, for more than 30 years it is actively to be victorious and dosed up to the full amount of "kishenkov" Ingulators. modern compressor іngalyators They have become widely victorious, occasionally recently - in the last ten years of the last century, and from the very beginning, the active term nebulizer, nebulizer therapy is not connected. People are looking at the pathogenesis of bronchial asthma, there is a new generation of non-steroidal anti-inflammatory drugs (inhalation glucocorticosteroids), a release of bronchodilator drugs for an inpatient inhalator appears. The very term of nebulizer therapy (substitute іngalyatsіyna) allowing the delivery of lykarsky speech not through dosages but a steam inhaler.

Nadal, in this methodical book, in the quality of a nebulizer, there will be no compressor inhalators.

If you say it is gross, then the nebulizer is a good fit, but it should be stored with:

· Compressor, like a grip of a grip;

· Aerosol chamber (nebulizer chamber), connected with a compressor through a tube, into the airosol;

· Zminnyh mouthpiece, masks or nasal cannulas.

In this case, there will not be a detailed examination of the budget and physical principle of the robotics of nebulizers. The stench is described in detail in інshih literary dzherels. The meta of certification is the most widespread approach to practical medicine and nutritional patients, concretizing the intake of nebulizer therapy in dear ones organ_v dikhannya, development, for a pity, deyaki pomilki.

How to use basic types of nebulizers?

Run the tip of the nebulizer:

· Direct-flow (approval of aerosol is drawn up permanently as for inhalation, so for vidihu); there are two types:
1) an extraordinary nebulizer that can be used in a continuous mode. The main shortcoming of the polarization is that the generation of aerosol appears in the phase of inhalation and vidikh of a sick person, in addition to which part of the aerosol (55-70%) is used to enter the atmosphere and to the medical personnel. Leech is a small (≈7%) part of the drink in the legend of the sick. Requirements for high flows of working gas (up to 6 l / hv);
2) a nebulizer that generates aerosol continuously and manually. It is characterized by the fact that, in the phase of ailments, there is a possibility of self-reliance on the appropriate aerosol, which changes its release into the atmosphere. You can also be victorious at the children, who learn to be highly disciplined.

· Kerovani dikhannyam, which is activated by inhalation (nebulizers Ventury). Start in winter mode. It can also produce aerosols continuously for an hour during the entire dichotomy cycle, so that the aerosol can be inhaled for an hour to open a special valve (valve), which is disassembled at the upper part of the chamber. In the area of ​​aerosol production, it’s worthwhile to add a dose of food, so that it can be brought up to an additional flow and, in such a rank, to improve the coverage of the aerosol. Before the hour the valve closes and the sick person pass only in one straight line, minus the area of ​​the product with aerosol, through the valve with a mouthpiece, to reduce the flow through the chamber. It is worthwhile to change the dose of the drug (up to 30%), I adjust the dose to inhale with aerosol. Changes in the busyness of the midst of the midst, the hour of nebulization. A nebulizer of this type does not use a forced-air compressor (sufficient flow rate of 4-6 l / hv). Until these shortages, the amount of strata is observed to the patient's flow and the increased frequency of the product to aerosol in case of viscous changes.

· Synchronized with reactions, dosimetric. It is controlled by electronics and grows to the rhythm of a sick person's dichotomy. The stench generates aerosol suvoro at the inhalation phase of a special valve, which is controlled by an electronic sensor. Theoretically, the ratio of input to aerosol is 100: 1 for an hour or so.

Yak vibrati nebulizer?

1. I have a post about the preparation of a nebulizer for medical mortgage, That neobhіdno pridbannya schonaymenshe dvoh tipіv - ram (dozvolyaє vikoristovuvati in dіtey i Zi patsієntіv znizhenim іnspіratornim ob'єmom vnaslіdok virazhenoї obstruktsієyu) i aktivuyutsya vdihom (abo sinhronіzovanі) - when їh vikoristannі on vidihu utvoryuєtsya aerosols less then i vіdpovіdno vіdbuvaєtsya-valued ekonomіya Liky.

2. The vibrator of the nebulizer for vikoristannya in the home minds to start with a classy situation, as it is necessary to discuss it with the doctor beforehand. For patients, with chronic chronic problems on the side of dickheads, as well as expensive drugs, it is more daring to vibrate nebulizers with a winter mode of delivery to aerosol.

3. It is necessary to provide the complete set of the nebulizer: mouthpiece, nasal cannulas and masks of different sizes.

· Mouthpieces (grown-ups and children) are optimal for feeding people very much in the legacy, for being vicky when ingaling by older children, as well as for children from 5 years.

· Hand masks for lіkuvannya of the upper dichally nobles and allow the development of all the emptying of the nose, pharynx, as well as the larynx and trachea. With vicorian masks, a large part of aerosols is deposited at the upper dichny paths. Masks are required for nebulizer therapy in children up to 3 years, so it’s unwise to carry out the inhalations in such patients through the mouthpiece - they dictate the children through the nis (the whole thing is summed up by the child’s anatomy). It is necessary to choose a mask of different size. Vikoristannya shіlno lays down masks change to aerosol in small children. Yakshcho a child older than 5 rocks, more beautiful than a vicoristovuvati mouthpiece, no mask.

· Nasal cannulas (tubes) are required for delivery of lykarsky aerosol to the empty nose. The stench can booty vicoristani in the complex treatment of hospitality and chronic rhinitis and rhinosinusitis

4. Slide your respect to the middle size of a lot of aerosol (less than 5 microns), as well as to the fluidity of the working gas flow (not less than 4 l / min).

6. When choosing a brand of nebulizer, it is important to make a decision to include additional ("spare") cameras in the kit, which can be added to them.

7. It is possible to transfer the nebulizer to a vikoristovuvati far away from the system. In some cases, there is an important level of noise when the compressor is robotic.

The approximate diagram of the pathology of the development of pulmonary pathology, which can be guilty of being diagnosed with a doctor in the presence of a specific clinical situation, is suggested below. It is necessary to remember that all guided lower than the preparation may be contraindicated until the indicated side effects However, there are no victories in previous advisors, or instructions, in these recommendations.

· Yak and all lykarski zasobi, preparations for the introduction through a nebulizer are guilty of being recognized as a drug in strictly recommended doses.

· A trial of nebulization is guilty of being in a hospital or in an outpatient department under the control of a doctor.

· Doses of the drug, attributed to nebulization, vische, nizh at inhalations with vicious doses of inhalators.

· The patient is guilty of worries about the failure of high doses, and even bronchodilating occurs on occasional doses of nebulizable breakdowns, the ailment is guilty of inaccurately turning up for the help.

Low-level preparations, guided in an extraordinary font, registered in the Republic of Bilorus (camped as of since 2008). The best possible preparations are in italics. Please name the preparations in the bows.

Bronchial asthma (BA)

In the pathogenesis of bronchial obstruction in asthma, three components may play a viral role (in the developmental stage of turn) - spasm of smooth muscles of bronchial tubes, swelling of the mucous bronchial tree, hyper- іdiscretion (reduction of rheological powers of the mucus). Nebulizer therapy can be tailored to all three components.

As a rule, a slight overload of the BA is not a problem for the suction of the nebulizer.

· BA of the middle stage of severity can be used for sucking the nebulizer, especially in the period of sharpening and for stopping attacks.

· BA of serious interruption is guilty of taking into account the lack of nebulizer therapy due to the decrease in the respiratory flow and, apparently, about the lack of efficiency of the dose of inhalers.

· Patients guilty of reading the instructions from the doctor about the technique of vikorstannya nebulizer and about the flow meter monitoring.

Likuvannya BA using the nebulizer is carried out for three straight lines:

· Kupiruvannya attack BA.

· Basic therapy of BA in outpatient minds.

· Lіkuvannya important asthma in the minds of the hospital, including asthmatic status.

Bronchial asthma attack

To stop a BA attack, 2 agony is recognized through a nebulizer in the offensive doses in the presence of the severity of the attack:

Fenoterol (Berotek) 0.5-1.5 mg abo Ventolin) 2.5-5 mg.

In case of BA attacks, it is supervised with a swiveling hypertension, and it is partially responsible for:

Combinations of bronchodilators (fenoterol 0.5-1.5 mg and ipratropium bromide 250-500 mcg). Abo finished form - Berodual (1-2 ml / 20-40 drops)

With low efficacy and poor tolerance of b 2 -agonism, mono-stagnation of holinoblokatory can be possible (at the top of the improved efficiency in spirometric tests)

Ipratropium bromide 0.5-1.0 mg.

In case of low efficacy of the bronchodilator therapy, it is possible to add additional IGKS

Budesonide ( Pulmicort) - 1.0-1.5 in one or two priyomi (after 30 minutes after the first ingestion.

With an inconsistent effect, you can repeat the inhalation with bronchodilators up to three times over a period of years. At every day of the day the effect of supplementing systemic steroids (prednisolone).

BA therapy in outpatient minds.

Nebulizer therapy for lung asthma is not easy in older adults who have reached the level of lykuvanny before DAI. Nebulizer therapy for moderately severe BA, especially, an important one, can be combined into three components, which is injected into all the elements of bronchial obstruction: bronchodilator therapy, non-steroidal anti-inflammatory drugs (IGKS), muco-regulating. Specified recommended dosages for moderately severe asthma, in the bows, aiming for the important.

bronchial therapy stock up on regular intake of bronchodilators, or combining nebulizer therapy for intake analogous drugs through DAI (for example, in the evening through a nebulizer, in the daytime through DAI).

Fenoterol (Berotek) 0.5-1.0 (1.5-2.0) mg abo salbutamol (Salgim, Salbutamol, Ventolin) 2.5 (5.0) mg - 2-3 (4-6) times a day. abo

Berodual (1-2 ml / 20-40 drops) - 2-3 (4-6) times a day.

protipal therapy through a nebulizer is carried out with inhalation glucocorticosteroids (IGKS). Іngalyatsіya ІГКС is carried out after 30 minutes of preparation.

Budesonid ( Pulmicort) - 0.5 (1.0-1.5) - twice a day.

muco-regulating therapy BA is carried out in case of porous borosilic-ciliary clence (thick thick sputum) with ambroxol.

Mucosolvan

The ingestion of growing drugs and acetylcysteine ​​in the outpatient drainage system for asthma is contraindicated.

Lіkuvannya severe asthma in the minds of the hospital, including asthmatic status.

At stationary minds, incl. The brigade of advanced aid in case of an important attack of asthma, nebulization is guilty of repairing with 5 mg of salbutamol, or in the combination of b 2 agonist plus 0.5 mg of cholinoblokatori (ipratropium bromide). If it’s good (for the assessment of physical tributes, dynamics of the PSV, the patient’s zagalny camp), it’s good, then it’s repeated nebulization of the skin for 4-6 years, stretching 1-2 dib.

In case of insufficient reasons, it is necessary to inject GCS internally and euphilin, and repeated inhalations with specified doses can be repeated after 4-6 years. In case of an outbreak of a severe attack for 6 years, the patient was diagnosed with asthmatic status. When transferring the patient to the LWL, the nebulizer can be included (a number of other devices are also secured with a nebulizer in the contour) of the nebulizer into the contour of the device.

With a swollen obrya of the mucous bronchial tree, it is possible to inhale adrenaline (permissible in the minds of intensive therapy).

· Adrenaline 1% - 0.2-0.3 ml in 5-6 ml. izotonic range.

In case of asthmatic status, direct mucolytics can be ingested

N-acetyltsistenin (Fluimucil) up to 1.2 g per dobu.

At the same time, it is necessary to remember about the need for additional sanitation (if there are ailments on the SHVL) for the collection of straight mucolytics.

Patients with severe asthmatic attacks before an hour of nebulization are guilty of guilty, but it’s possible, because they have 2 agony that can cause arterial hypoxemia.

Chronic obstructive ailments (COPD)

In the pathogenesis of bronchial obstruction in COPD, two main components may play a viral role - spasm of smooth muscles of the bronchial tubes and hyper- and (abo) dyscrasia non-permanent component i maє rіznu steps swelling in the fallowness of the form and stage of the ailment . Singing meaning maє bacterium fired in the development of aggravation and severe overload of COPD. However, infection is not the only reason for COPD aggravation, but in 1/3 of the cases, the reason for fever cannot be identified.

The treatment of COPD from the nebulizer is carried out in the fallow state of the stage and the degree of severity and is stored in five straight lines.

· Bronchodilator therapy - basic therapy, obov'yazkova for treatment of all ailments on COPD.

· Antibacterial therapy (if necessary).

· Therapy ІHKS (if necessary).

For patients with important chronic bronchitis and hypercapacitus, as a rule, it is not safe and, therefore, for nebulization of the drug vicoristovyuyu after.

Bronchodilator therapy for COPD.

Bronchodilatory therapy for COPD is found in the severity and stage of the ailment (aggravated, unstable remission, remission). Above all, it is medium-heavy, and especially, an important transition to the use of nebulizer therapy. With FEV 1<35% должной величины использование ДАИ неэффективно. Холинолитики являются средствами первого выбора при лечении ХОБЛ как более эффективные, чем b 2 -агнисты. Однако, синергизм комбинации этих препаратов позволяет рекомендовать их одновременное применение.

Ipratropium bromide (Atrovent) 0.25-1.0 mg (1-4 ml.Rose) 2-4 times a day in the presence of the degree of severity (variability of obstruction) - monotherapy is recommended only in case of mild interruption of COPD due to the need for a posture or moderately severe sharpened.

Combination of bronchodilators (salbutamol 2.5-5.0 mg and ipratropium bromide 250-500 mcg) - 2-4 times per dose. Abo the ready form - Berodual (put in 1 ml (20 drops) 250 mcg of ipratropium bromide and 500 mcg fenoterol hydrobromide) - 1-2 ml. / 20-40 drops - 2-4 times for doba, with important sharpening up to 6 times.

Mucolytic and muco-regulating therapy.

Victory in the capacity of mucolytic enzymes in proteolytic enzymes is unacceptable for the development of serious side effects - hemoptysis, allergy, bronchoconstriction.

Ambroxol will shrink mucociliary transport, which, in the meantime, is mucokinetic due to the accumulation of changes in the form of an ectopic effect. Trivial use of the drug significantly reduces the frequency and severity of COPD aggravation.

Ambroxol (Ambrobene, ambrohexal, Lazolvan, Mucosolvan) 30.0 (60.0) mg twice a day. You can do it in the middle of the dobovyh dozuvan zenteralny zasosuvannyam.

Acetylcysteine ​​(ACC) is a strong form of a school of proteolytic enzymes. Sulfuric groups of these molecules open disulfide links of mucopolisaccharides of phlegm. Prior to the development of phlegm, produce and stimulate mucosal cells. Acetylcysteine ​​increases the synthesis of glutathione, which takes a part in the detoxification processes. It is especially significant for the patients of the kidnapped and old man. In some cases, the mucolytic effect of acetylcysteine ​​can be caused by the fact that the mucociliary transport is negatively infused into the camp of mucociliary transport, as well as the overwhelming reduction in the viscosity of a secret. Tim by the hour acetylcysteine ​​inodіdіnіtnіy nadavati oversupply rіzrіzhuyut the effect, which can viklicati the syndrome of the so-called "flooding" lungs.

· Acetylcysteine ​​(20% solution) - 3-5 ml 2-3 times a day.

N-acetyltsistenin (Fluimucil) - 300 mg (3 ml solution) 2 times to add.

If there is a need for mucolytic therapy and an infectious process in TBD, the combined preparation of acetylcysteine ​​and thiamphenicol (antibiotics of a wide range of activities) -

· Fluimucil-antibiotic IT - 2.5 ml of ready-to-use solution twice a day.

carbocistein normalization of acid and neutral sialomucines in bronchial secretion. When the drug is injected, the regeneration of the mucous membrane, a decrease in the number of cell-like cells, especially in the thermal bronchi, is seen, so that the drug is a volodyne mucous membrane and mucolytic effects. At the same time, IgA secretion and the number of sulfhydryl groups are observed. One drug It doesn’t get stuck.

antibacterial therapy.

For ailments on COPD, it is not often the case that they become infected with infection. Antibiotics are recognized in the presence of clinical signs of intoxication, an increase in the amount of sputum and the appearance in some new elements. The most effective method of determining the participation of bacterial infections in the aggravated COPD in the area of ​​clinical analysis of harkotinnya (cell warehouse) is to increase the number of granulocytes in more than 60%. With a decrease in FEV1 below 40%, the infectious process becomes reliable. The name of the word is meant to be empirically and triumphant 7-14 days. Pidbir antibiotics for sensitivity of flora in vitro is carried out with ineffectiveness of empirical antibiotic therapy. For the ingestion of aminoglycoside antibiotics. In case of infection with TVD, viclikan sygnigny with a stick - colistin, Dioxidin.

· Gentamicin 40 mg (2 ml) twice a day.

· Kolimitsin - 0.5-1.0 million IU 1-2 times per day.

Dioxidin (Dioxidin, Hindiox) - 100-300 mg twice a day.

In important cases of infectious disease and low efficiency of antibiotic intake of antibiotics, the combination of antibiotic intake is shown (with the other methods of introduction). Antibacterial therapy, as vidomo, sometimes increases the viscosity of sputum due to the development of DNA during the lysis of microbial cells and leukocytes. At the connection with the cym, it is necessary to come in so that the rheological power of the sputum and lays down on its appearance is necessary. In all types of AB, there is a lot of stasis of ambraxol (div. Vishche). With a one-hour intake of antibiotics, Ambroxol pushes into the bronchial secretions and mucus membranes of the bronchi, promoting the effectiveness of antibacterial therapy and speeding up triviality.

IGKS therapy (if necessary).

Indications for corticosteroid (CS) therapy for COPD є ineffectiveness of the maximum doses of the basic therapy - bronchodilator diseases. The efficacy of corticosteroids in patients with chronic obstructive pulmonary disease (COPD) is not the same. If only 10-30% of patients have bronchial passages when they are stagnant. In order to ensure that the nutritional status of the systematic intake of corticosteroids is complete, it is necessary to conduct I will try oral therapy: 20-30 mg / add with rosrakhunka 0.4-0.6 mg / kg (according to pre-nizolone) with a stretch of 1-2 tijn_v. An increase in the response to bronchodilators in bronchodilator tests by 10% of the existing values ​​of FEV 1, or an increase in FEV 1, at least 200 ml per hour to indicate a positive infusion of corticosteroids in bronchodilator progression. Even during the test-therapy of CS, there is a bronchial passage, which allows the effective delivery of the ingestion form of the drug in the lower part of the hospital, we have a problem. іngalyatsіynі form KS.Іngalyatsіya ІГКС is carried out after 30 minutes of preparation.

Budesonid ( Pulmicort) - 0.5-1.0 - twice a day.

Zastosuvannya prednizolone (5 mg inhalation two times a day or dexamethasone 2 mg once a day inhalatively) is possible, albeit according to the improvement of clinical efficacy is not presented.

With a one-hour appointment, the drug should be taken into account. The first inhaled bronchodilator, after 10-15 quiline - vidharkuvalny, potim;

Іngalyatsіyna broncho-sanitation therapy for COPD.

The inhalation of broncho-sanitation therapy is directed to the maintenance of secrecy from the theater of operations. It should be carried out 1-3 times during the next week. Wikoristovuyutsya slightly alkaline mineral water and or physiological breakdown of sodium chloride. Allow the mucus membrane on all sides, to help the catarrhal manifestations, to grow a small part of the bronchial secretion.

· "Borzhomi", "Narzan" (mineral water needs to be taken before degassing), 5-6 ml per ingalation. For the purpose of engaging, it is necessary to conserve dichy gymnastics with the elements of a forced vidihu, to do it completely with vibrating massage (self-massage).

Protecting hypertension through the possibility of increasing the number of sputum and strengthening the bronchial obstruction. Stagnate at the edge of the high sputum.

· NaCl2-3% 4-5 ml vrantsі through a nebulizer.

pneumonia

Nebulizer therapy for pneumonia is indicated in times of admission of a gastrointestinal bronchitis or an acute acute bronchitis (Div. Vishche). In some cases, it is not complete, except for the ingestion of Ambraxol, and in severe cases, it is not sufficient for the consumption of immunomodulators.

Ambroxol (Ambrobene, ambrohexal, Lazolvan, Mucosolvan) 30.0 (60.0) mg twice a day.

Leukinferon - 1 ml of leukinferon in 5 ml of physiological rose. Check out the internal language introductions. The first time interval with an interval of 2 days - vrantsi іngalyatsіyno, in the evening the drug was administered internally. Nadal with a stretch of 1-2 vykoristovuyut only the internal method of introducing the drug 2 times per week.

In case of a threat (or a cob) of abscess formation with a severe interruption of pneumonia, an anti-enzyme preparation is indicated.

· Kontrikal 5000-10000 OD 1-2 times a day until the ear is allowed pneumonia.

Bronchiectatic ailment (BAB).

Likuvannya BEB from the nebulizer is carried out in the fallowness of the width and the degree of severity and is stored in three straight lines.

· Іngalyatsіyna broncho-sanitation therapy.

· Mucolytic and muco-regulating therapy.

· Antibacterial therapy (periodically after indicated).

I is recirculated to the drainage polish in uzhennyh viddilakh. All three strains of the ingestion therapy are described in the section of COPD (Div. Vishche). With a slight interruption, BEB therapy is carried out only during the period of aggravation. With a moderate and heavy interruption іngalyаtsіyna broncho-sanitation therapy it is guilty that it is carried out periodically if necessary mucolyticsі vikorystannyam position drainage.

· Acetylcysteine ​​(20% solution) - 3-5 ml 1-3 times a day.

N-acetyltsistenin (Fluimucil) - 300 mg (3 ml) 1-2 times to add.

By virtue of frequent antibiotics in case of BEB, the intake of recommended antibiotics is taken away from them.

In case of diffuse bronchial bronchitis and an important interruption of BEB, anti-enzyme drugs can be consumed

Contrikal 10,000 OD once a day 3-7 times per day for 2-6 days

Overbig BEB often accelerate COPD, the therapy of which is described in the throat.

I will become.

Induced sputum technique.

A method is given for stagnation for discarding phlegm for older species of a child (in the first place for identifying and identifying an animal - specific and nonspecific).

· Vikoristovuєtsya 4% razchin hydrocarbonate or sodium chloride 5-10 ml through a nebulizer with further coughing through 10-30 minutes after three forced vidikhiv.

Zastosovuvati with protection in patients with chronic damage to the theater through a possible increase in the amount of phlegm and the appearance (improvement) of bronchial obstruction.

If you are sick, you need to be promptly involved, and you will be at the HVL.

Prophylactic nebulizer immunomodulatory therapy reduces the incidence of pneumonia by 2.5 times and mortality by 1.4 times, and also reduces the amount of lesion tissue. Nebulizer immunomodulatory therapy

· T-activin is carried out according to the offensive scheme: 4 days before the operation, 3 days before the operation, and also on the day of the operation, one-time for a visit at the evening in a dose of 200 micrograms.

· In the presence of chronic infections, it is necessary to add nebulizer therapy with gentamicin. Before one operation, on the day of the operation and one day of the day (in times of the SHL during the operation and more than one day) - 40 mg. to gentamicin in the doorway of the Ingalyatsiya.

Stagnation of antibiotics is not an alternative to antibiotic therapy with other delivery methods, and if you do not increase the frequency of infectious diseases from the side of the dykhalny nobles.

An analogous course of immunomodulatory and antibacterial nebulizer therapy is indicated for patients who spend a trivial hour on the SWL.

Preparation for fiberoptic bronchoscopy (FBS).

It is traditional for anesthesia techniques and the adjustment of the cough reflex during preparation before bronchoscopy є

Inhalation of 4 ml of 2% lidocaine through a mask (with superficial dichannel and inhaling dichotomy for 2 seconds) before the procedure.

The interval between the ingestion and the cob of bronchoscopy is not more than 5 minutes. For cich purposes, it is necessary to have an endoscopic view (cabinet) with a nebulizer. Obsya lidokainu, vikoristovuvanogo bezposeredno in the process of FBS, is guilty of butti reductions.

Conducting adequate bronchial-alolar lavage is uncomfortable without inhalation of lidocaine. 6 ml of 2% lidocaine through the mouthpiece when the dyhanna is lost without prior to the procedure.

When bronchoscopy is carried out for patients with broncho-obstructive pathology, it is necessary to prescribe bronchodilator drugs (preferably vikoristovuvati atrovent) for 30 minutes before FBS for the prevention of bronchospasm for an hour or so during bronchoscopy.

visnovok

The given recommendations, as well as the choice of pathology and recommended doses, are used for older patients, even if the doses are corrected, it can be fundamentally victorious in pediatric practice. Possibilities of the ingestion therapy for those who are not sick or for specific illnesses of those who have not been included in the recommendations (tuberculosis of the organs of health, cystic fibrosis, respiratory distress syndrome) in those

The position of evidence-based medicine, nebulizer therapy, illnesses of organisms are promising directly in the likeness of illnesses in the minds of the day. However, in order to reject a cleaned-up effect from a disease, it is necessary: ​​to maintain adequate educational annexes, special Likarsky forms for English-speaking, correct procedures for continuous monitoring of the efficiency of the side of the eye.

literature

1. Avdov S. "Victory of nebulizers in clinical practice" // Rus. honey. journal / Pulmonology. - 2001, - T. 9, No. 5. - S. 189-201.

2. Avdov S. "Attachments for the delivery of inhalants, how to get rid of during the treatment of illnesses of illnesses" // Rus. honey. magazine - 2002; - T. 10, No. 5. - S. 255-261.

3. Avdev S., Anaev E.Kh., Chuchalin A.G. Stagnation by the method of induced sputum for the assessment of the intensity of the firing of sputum paths // Pulmonology. - 1998. -№ 2. - S. 81-86.

4. Alexev A.A., Krutikov M.G. Yakovlev V.P. Antibacterial therapy in complex treatment and prophylaxis of infectious diseases in patients with diagnoses // Rice. honey. zhurn. -1997. -T. 5, No. 24. - P. 45-51

5. Bronchial asthma. Certainty for patients in Russia (formulary system) / Pulmonology, supplement. - M., 1999 ..

6. Global strategy of treatment and prevention of bronchial asthma / Ed. A.G. Chuchalina - M .: Atmosphere, 2002 .-- 160 p.

7. Gurevich G.L. / Nebulizer therapy for ailments of organs of dichannia. // Minsk: Unitary Enterprise "Universalpress", 2003.

8. Arshov A.A., Cherkavskiy O.P. Nebulizer immunomodulatory therapy is a method for the prevention of pneumonia in cancer patients. // Pic. honey. zhurn. -2003. -T. 15, no. 24.

9. Preschool help we have a problem with bronchial asthma: Method. Recommendations / Department. CLINICH. pharmacology and internal ailments MDMSU. - M., 2001 .-- 46 p.

10. Zhilin Yu.N. Nebulizer therapy from the use of the Boreal inhaler: Method, recommendations for patients. - M, 2001 .-- 16 p.

11. Clinical biology of the lungs in normal and in pathology. Kerіvnіstvo for lіkarіv / Ed. V.V. Erokhina and L.K. Romanova. - M .: Medicine, 2000 .-- 496 p.

12. Prince N.P. Triva therapy of bronchial asthma // Rice. honey. zhurn. -1999.-T. 7, No. 17.-P. 4-13.

13. Korovkin B.C. Likuvannya ailment of bronchial tubes and legends: Dovidnik. - Minsk: Bilorus, 1996 .-- 175 p.

14. Laptava I.M. Nebulizer therapy in pulmonology // Med. Novini. -2002.-№7.-p. 59-61.

15. Ovcharenko S. І. Mucolytic (Mucoregulatory) drugs in the treatment of chronic obstructive ailments of the legen // RMZh.- 2002.- T. 10, No. 4.

16. Ovcharenko S.P., Peredil'ske O.A., Akselrod A.S., Morozkina N.V. Dosvid of stasis of nebulizer therapy in patients with severe bronchial asthma // KLINICH. Medicine. - 2002. - No. 2. - S. 63-66.

17. Register of Russian Likars: Encyclopedia of Likes: Yearly. Zb. ... M .: TOV RLS - 2006. - VIP. 13. - 1457 p.

18. Sinopalnikov A. I., Klyachkina I. L. Misce of mucolytic preparations in complex therapy for ailments of the organs of the body. Russian Medical Visti, 1997; 2 (4): 9 - 18.

19. Dovidnik Vidal: Drugs in Russia. - 10th ed., Revised., Rev. і add. - M.: A

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Nebulizer therapy: practical essential

Natalya Trushenko

In this hour, in the most effective way to get sick of the mental system, it is by right to take on the ingestion therapy. For additional information, there is an addressable delivery - in the form of a message, the correct delivery of the lykarskoy speech without the need to go to the bronchi.

For the current day, one of the key positions in the English therapy is taken with the aid of a nebulizer. A nebulizer (derived from the Latin word nebula - "fog", "hmara") is a trick, which is a re-creation of the rіdki form of lіkіv in other droplets (aerosol hmara) and prevents the delivery of lіkіv in the lower wards.

The nebulizer therapy has a number of non-listed passages:

Effective delivery of lekiv without the presence of the middle in the bronchi;

Simplicity of vikonannya іngalyatsіy (delivery of lіkіv pіd hour spokіynogo dikhannya);

Adequacy in the legends of liquids in a pure viglyad, the visibility of propellants (additional houses, for example, yak in balloons with dosed aerosols);

A decrease in the number of leaks, which is deposited in an empty company, is slightly moistened in the roof and in every case of a change in side effects.

The most important role of nebulizer in the treatment of chronic diseases of the organs of the disease - bronchial asthma, chronic obstructive ailments, lungs, bronchiectatic ailments, mucoviscidosis. If I want to use nebulizer therapy in singing situations, I can provide unappreciated help in pneumonia, bronchitis, cereals and a number of other diseases.

Vibir nebulizer model

When the nebulizer is vibrated, it is necessary to clearly identify the goals and the establishment of the nebulizer in the future; If I have ailment, I’m going to get sick for help, some drugs, if I’m a lot of people, I’ll be koristuvatisya, some members of the family, vik koristuvachiv.

According to the principle of robotic nebulization, it is possible to move on the offensive tip, in the case of skin diseases it has its own passages and shortages (Table 1). Compressor nebulizers, in which likarska speech is split into aerosol by a forced stream of povtrya, which is pumped by a compressor. The most popular and universal type of nebulizers.

Table 1. Nebulizers and shortcomings of different types of nebulizers

Nebulizer type Perevagi Nedolika

Compressor Possibility of vicariousness to be-like medicinal preparations Reasonably cheap Great vibration of models Increasing noise Thunderousness

Ultrasound Compactness (model deeds) Noiselessness Great chamber treatment Great productivity (ml / h) Great surplus preparation Є preparations that can run out before ultrasonic problems (budesonid!)

The Mesh-nebulizers (membrannі) Portativnіst (naymenshy nebulizer in svіtі) Bezshumnіst Mozhlivіst vikoristovuvati whether SSMSC Liky Mozhlivіst Venue of іngalyatsії recumbent Bіlsh ekonomne vitrachannya Liky Mensch trivalіst іngalyatsії Mozhlivіst zasmіchennya mіkrootvorіv membrane chastinkami aerosols at nedotrimannі rules ekspluatatsії Vimagayut bіlsh retelnogo doglyadu Visoka Price

SCHOOL OF LIFE

Attach the nebulizer: 1 - nebulizer chamber, 2 - air-duct tube, 3 - compressor.

Ultrasonic nebulizers, which can be used for additional ultrasound. Їх often vicarious in physiotherapeutic treatment of medicines. In a routine vicarious їkh head shortage - the unkindness of victorious a number of faces (for example, budesonіda).

Mesh-nebulizers (derived from the English word mesh - "sieve"), how to open the lykarsky rozchin by means of a path through a vibrating mesh-membrane (a plate with multiple microscopic openings). The price of new generation of nebulizers, for which they are called: membranes, electronic parts, nebulizers based on vibrating sieve technology (Vibrating MESH Technology). In cich nebulizers there are a number of hundreds of nebulizers (div. Table 1). However, there is a possibility of confusing miniature openings with aerosol particles if the rules of exploitation are not well controlled.

The skin nebulizer is stored with a nebulizer chamber for sawing (or even a nebulizer), a lock for inhalation, a compressor (rotary pump) or

Table 2. Technical vimogs to compressor nebulizers (European standards)

Size of particles to aerosol> 50% due to buty in the range of 1-5 microns

Residual debts<1 мл

drug

an hour of іngalyatsії<15 мин (для объема 5 мл)

to the gas<10 л/мин

Working vice 2-7 bar

Productivity> 0.2 ml / hv

Compression chamber> 5 ml

ultrasonic generator (babies). The compressor and the nebulizer chamber are connected between themselves by the duct-tube, by which they are squeezed into the chamber. At the nebulizer chamber, the leaks are transformed into aerosol, which requires dichati through a face mask or a mouthpiece. Pay your respect for the additional set of accessories: the appearance of the nozzle for the nose (cannula), the adapter of the changing strum, the number of changing filters, the amount of the air tube; for children, the appearance of a child's mask is important, an easy attachment (play-nozzles on the camera or a play form of a nebulizer).

When vibrating the model of the compressor attachment, the slid spirals on the technical characteristics, which are specified in the European standards of nebulizer therapy prEN 13544-1 (Table 2).

When raspilyuvanny particles with a size greater than 10 microns settle (і, apparently, pour) into the oropharynx, 5-10 microns - in the throat, larynx and trachea, 1-5 microns - in the lower spinal paths (bronchi), 0.5-1 microns - in the alveoli (legeny pukhirtsi, which is located on the ends of the bronchial tubes, through the yak, the muslin penetrates into the roof). And the parts less than 0.5 microns will be zalizhayutsya in vіtrі, do not settle in the organs of dichotomy and vіlly go out when vidihu.

To that, before all the nebulizer, a vimog should be placed, not less than 50% of the parts in the aerosol buli with a size of 1 to 5 microns. The main characteristic of the dermal nebulizer is the so-called respirable fraction - a piece of particles (in vids) with an aerodynamic diameter<5 мкм в аэрозоле. У хороших небулайзеров респирабельная фракция составляет порядка 75%, данный показатель индивидуален для каждой модели и должен быть указан в инструкции к прибору.

For some models of nebulizers, it is possible, with the aid of singing nozzles, to regulate the size of the parcels in lyuvial aerosol. It is possible to differentiate between lower (bronchial tubes) and upper (trachea, voices, nasopharynx) dichally. Є nebulizers, specially designed for the treatment of chronic sinusitis (sinusitis). True, the optics' dues are literally poured into the Kintsev partiality.

A lot of modern nebulizers are equipped with a system of valves in the inhalation and in the vidih, or the so-called system of "virtual valves". It is very obvious and attached to the valves to lay the steps at the bottom of the line.

Terms of use

The dermal compressor and dermal nebulizer chamber have their own characteristics,

Asthma and allergy 4/2015

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In addition, the combination of a compressor and a camera is not a guarantee of an effective nebulizer robot. Slid vikoristovuvati compressor and nebulizer camera of the same virobnik.

In children of an early age, it is recommended to use a face mask of different size for inglyacies, if it is necessary, the mask would adhere as gently as possible to the face to interfere with the contact of the face from the point of view, change in the loss. For children of 3 years and for older ones, it is more beautiful to wear a mouthpiece for ingestion through the mouth; Nose cannulas are required for delivery of liquids to the empty nose. The stench can be vicious in the complex treatment of hospitals and chronic rhinitis and sinusitis.

In case of excess consumption (a parameter that should be included in the instructions before the attachment), less than 1 ml of a supplement of the drug can be 2.0-2.5 ml, and in case of an excess of 1 ml, it is necessary to close 4 ml of the preparation at once with the retail box. The maximum amount (liquids + razchinnik) - 8 ml. Obsyag age, recommendations for sawing, in most nebulizers to become 3-5 ml. For yogo up to a lykarsky drug, it is necessary to add a physiological solution. There is no need to pick up food and mineral water for ciches!

Absolutely in all models, it is impossible to admit that the line gets into the compressor and twist the compressor before the hour of the robot.

The average hour of one ingalyation is 5-10 minutes. It is necessary to lay down for a specific type of nebulizer (shvidkostі stream), obsyagu lіki (lіki + rozchinnik), obsyagu nebulizer chamber. Every time you can use the nebulizer, it falls through the fluidity of the jet, and the size of the part grows. The term of service of the nebulizer chamber of development (from 3 months to 3 years). Do not forget to change the filter too soon (spare filters are included in the package).

Zberigati nebulizer is more beautiful in the selected viglyad for greater protection of universities.

technology of English

1. Before an hour of ingestion, you need to sit, do not swing, and trim the inhalator straight. Do not slide forward, so as to make it difficult for the aerosol to go in the wild.

2. Vikorist only tіlki tіlіki, as signifying a licar. Likas for ingalyatsy are guilty of the room temperature.

3. Fill the nebulizer only without needing to be in the middle before the inhalations, and with a sterile syringe (for 2.0 or 5.0 ml). There is a lot of physiological differences and also some of the likes. At the same time, the most concentration of the drug will be lost at the bottom of the chamber.

4. Press the mouthpiece with your teeth, grip the mouthpiece with your lips. For an hour, you may need to dichati, generally, through the mouth, you can trim the dichotomy for 1-2 seconds before the vidih. Alle yakscho tsya recommendation is undeniable, nothing scary, it can be simply spokyno dichati. Remember, it’s often and more difficult to get rid of it.

5. Finish the inhalation todi, if the sound changes, go out of the nebulizer chamber (the "spike" appears), end the vision of the aerosol from the nebulizer, licks in the chambers.

6. For the ingestion of corticosteroids (budesoni-yes), it is necessary to rinse your mouth with boiled water at room temperature, in the case of the mask, the mask is retractably held in place, do not dry up the area of ​​the eyes.

Nebulizer treatment

To prevent crystallization of drugs and bacterial obstruction for nebulizers, you need to look carefully. The casing is especially important for mesh nebulizers. In case of blockade of the pyr-mesh membrane, the nebulizer may become overloaded before the generation of aerosol, however, the specific characteristics and the therapeutic effect of aerosol may be significantly damaged.

Pislya іngalyatsії Nebulizer needs to be washed with warm clean water. For processing, it is not necessary to fix the brushes and yorzhiki. Beast to respect, for the small parts of the nebulizer, the ways of processing are processed. For example, the Pari nebulizer cannot be inserted into the tube. In the mesh nebulizer, the membrane can be rubbed with your fingers or with soft sticks, and cleaned simply with a stream of warm water.

When one and the same decilcom nebulizer is victorious, people need to disinfect (sterilize) the nebulizer chamber for dermal people. In case of regular regular vicarious disease, one human disinfection should be carried out once a day.

The sterilization of the nebulizer can be carried out in a selected viewer for an additional hot bet, for example, in a steam sterilizer, designed for the processing of baby dances. A large number of parts of the nebulizer chamber (for a vignette of masks with polyvinyl chloride, silikonovy valves, div. Instructions to a specific attachment) is possible

SCHOOL OF LIFE

kip'atiti. Alas, there is enough water in the pool of water (all parts are to blame for the water).

Before folding all parts of the nebulizer are guilty of hanging. Dry the nebulizer at room temperature by placing the parts of the nebulizer on a dry, clean, non-fibrous towel. You can vikoristovuvati for hanging by the hair dryer.

Nebulizer strips

To carry out nebulizer therapy, one needs to use only specially designated for cychic purposes. In these preparations, a small part of the difference in the aerosol is taken into account in all the licenses of power. The stench is on sale in the form of bottles or plastic containers - ampoules (nebuli), which allow them to be manually dosed.

The nebulizer is used for the delivery of bronchodilators, drugs, corticosteroids, antibiotics and other drugs.

For the sake of bronchospasm, it is possible to use bronchospasm with bronchodilating drugs from children groups (phenoterol, salbutamol and ipratropium bromide) and other combinations (for example, salbutamol + ipratropium). Significantly shortening the nebulizer support є a wide range of possibilities in an individualized dose and delivery of messages to the bronchi in case of severe bronchospasm.

In addition, the nebulizer allows for active anti-firing therapy for an additional form of corticosteroid budesonide. Ingalyatsії budesonіda through a nebulizer allow to solicit a shy antiapalny effect. At the same time, the development of side effects is significantly less than at the time of vicious corticosteroids in tablets, or internally. Explain the process, how can the systemic blood flow reach?

only 6.5% of the dose for children and 14% of the dose for the grown-ups, at that hour, when the whole intake is in the middle of the prenizolone, the first time to eat in the dormant way, to appear in the blood of the sick. In addition, the use of budeson-booths behind the aid of a nebulizer allows you to change the need for pills, internal hormones.

The last day (dose, frequency of introduction, name of the leaks) on the type of an important attack of asthma should be discussed in advance with the doctor. The specific scheme is selected individually.

Not less important is the nobility and the transformation of the faces, as it is NOT POSSIBLE to use nebulay-Zera for the help.

1. All the issues, how to take revenge on oils (not safe for health!). For the ingestion of oil vapors, use the vapors of the inhalator.

2. Suspensions - formulas and infusions of herbs, mixtures for coughs, rinsing rinses. Inhalation of cich coats behind the aid of a nebulizer is absolutely ineffective. In addition, the vicarious actions of them can lead to a nebulizer.

3. Likas, as they do not think of inhalational forms and do not go to the mucus of the bronchi, - theo-phillin, eufilin, papaverine, platifilin, anti-histamine drugs (diphenhydramine, diphenhydramine and іnshі).

4. Systemic corticosteroids (dexamethasone, hydrocortisone, prednisolone and іnshi). Ingalyation is technically possible, ale the action will not be miscellaneous and become systemic, due to the potential acceleration.

On the current day, nebulizers have already migrated to medical practice. Victimization of nebulizers is very expanding in the ability to treat ailments of the mental system in household minds, changing the need for hospitalization, allowing the development of important fires to be developed, chronically in case of unhealthy

Asthma and allergy 4/2015

Material of indications for patients

nebulizer therapy

GOSTRIKH I CHRONIC

ZAKHORYUVAN DIKHALNIKH SHLYAKHIV

Moscow 2006 Valentina Petrivna Dubinina - candidate of medical sciences, head of the phthisiopulmonology department of the Central Clinical Hospital of the Russian Academy of Medical Sciences, correspondent member of the Russian Ecological Academy, pulmonologist, phthisiatric department of the higher category.

Reviewer - Doctor of Medicine, Head of Anesthesia, Reanimation and Intensive Therapy of the Central NDI Tuberculosis of the Russian Academy of Medical Sciences - Yuriy Mikolayovich Zhilin.

PERDMOVA

With a thorough understanding of the inhalational apparatus, all the more roses offer the potential for nebulizer therapy as a way of delivering drugs directly to the target organ - the lungs, upper and lower dysfunctional ways.

Nebulizer aerosol therapy is the best and quickest way of delivering blood vessels to the lungs, the alveoli and the lungs blood flowing from the enteral or parenteral way, since the liver diseases, the intestinal tract passes through the intestinal tract,

Aerosol therapy from hospitalization Nebulizer inhalators are more and more available in an outpatient clinic, polyclinic practice, at home. For those who wish to serve Methodical recommendations, breakdowns in the field of pulmonary diseases in the food category, Candidate of Medical Sciences Valentina Petrivna Dubinin, who is very good at the transformation of the respiratory chronic nebulizer hospitals

JOIN

Hospitals for diseases of the upper dysfunctional paths are the most frequent diseases in outpatient practice, and not only otorhinolaryngologists, ale and therapeutics, pediatricians, pulmonologists and other diseases are involved. Ailments are called tse zhvoryuvannya cold.

Significant part of the state-of-the-art infectious diseases of the upper dysfunctional paths is the virus of influenza, parainfluenza of 4 types, rhinovirus, enterovirus, respiratory syncytial viruses, coronavirus, adenovirus and herpes simplex virus.

Viruses are one of the reasons for the aggravation of bronchial asthma and chronic obstructive diseases of the legends. Over the last 20 years, the incidence of respiratory infections has grown up. According to V.F. Uchaikin, influenza and RH in our country occupy the first place in the foreign structures of infectious diseases of the respiratory tract in children and adults and store 85-88% (Fig. 1).

Infectious diseases of the respiratory tract.

Uchaikin V.F. Theses of additional articles "Modern technologies in pediatrics and child surgery" -M., 19-20, XI, 2002

If not only viruses, they flicker to ignite the upper dyshal paths (rhinitis, sinusitis, tonsillitis, otitis), but they can be bacteria, fungi, internal pathogens and associations.

As a result of the destruction of the power of the body, the ignition process of the upper dichal paths can descend into the lower head of the tilny path and the vicious aggravation of chronic ailments of the bronchogenic system.

Already, the head staff of the doctor is effective in the treatment of hospital infections of the VAR (upper secondary paths), prevention of accelerated and early aggravation of chronic processes in the minds of outpatient and clinical practice.

The modern complex methods for the treatment of ignition grips in otorhinolaryngology include various combinations of medicinal preparations and methods for pouring onto the primary medium.

- [Line 2] -

Indicated: prevention and suppression of attacks of bronchial asthma, treatment of chronic obstructive ailments and lesions.

Dose: the drug can become stagnant in the form of rotations and severity of broncho-obstructive syndrome, and it can become stagnant in the unreduced viglyad at a dose of 0.5 mg / kg mass, or not more than 5 mg per dose.

Slid to guard against large doses of Ventolin and not to allow the difference in the eyes.

Berotek is a bronchodilator, 0.1% in vials of 20 ml, contains 1 mg of fenoterol hydrobromide in 1 ml, 20 drops in 1 ml.

Indicated: acute acute bronchial asthma, prevention of asthma of physical disease, basic therapy of moderate and severe asthma exacerbation, treatment of important acute chronic obstructive ailments.

Dose: in case of hypertension of bronchial asthma, we will grow up to 1 - 2 ml 4-5 times per dob ("for demand" to stop bronchospasm); for children up to 6 years - 5-10 drops up to 3 times a day, and for children over 6 years - 10-20 drops 3 times a day. For the prevention of asthma of physical zusilla, we will grow up and children 6 posilannya - 1 4 rokіv should be given 0.5 ml (10 drops) per cutaneous intake up to 4 times per day; for basic therapy of moderate and severe bronchial asthma, 0.5 - 1 ml per 3 - 4 ml physiological dose 4 times a day through a nebulizer.

In case of chronic obstructive ailments, the disease is in the acute phase of 0.5-1.5 ml per skin inhalation 4-5 times per day.

In case of an overdose of the drug, side effects can be caused:

nervousness, heart attack, tachycardia, tremor, cough. Vva zhaєtsya, which is more beautiful than vikoristovuvati berotek for demand, nіzh take it permanently. You can get one in one berotek with anticholinergic diseases and mucolytics.

Anticholinergic drugs Atrovent ("Boehringer Ingelheim" Austrian anticholinergic, 0.025% solution in 20 ml vials, put 0.25 mg of ipratropium bromide in 1 ml, 20 drops in 1 ml).

Indicated: prevention and treatment of reversible obstruction of mental illness in bronchial asthma and chronic obstructive ailments and lesions. Effective in children and children with ailments, if there are no bronchodilators.

Dose: for outpatient basic therapy for adults, 1 2 ml to 4 times per dose (both independently and in combination with beta-agonists).

It is distributed in physiological range up to 3-4 ml in a nebulizer.

For children up to 1 rock, 10 drops 3-4 times for doba.

Atrovent is a first-choice preparation for nebulizer therapy for hypersensitivity and trivial basic (basic) therapy of COPD.

With COPD in a large number of vipadic patients, the atrovent surpasses for its bronchodilatory effect of beta-adrenomimetics, but not for bronchial asthma. Not a vicious sound with a trivial reception, effective in children and children with ailments, if there are no bronchodilators. It is safe to drink at large doses. There are not a few systemic side effects of low moisture content through the mucus membrane. That is why the atrovent is seen as a change in front of beta-adrenergic markers, especially in those with ailments with concomitant heart-vascular disorders. However, the stasis of atrovent is not necessary for glaucoma, arterial hypertension, significant tachycardia and tachyarrhythmia, intestinal atony.

Berodual ("Boehringer Ingelheim" Austria - a combination drug to avenge m-holinolytics of ipratropium bromide (350 mcg) and agonist fenoterol hydrobromide (500 mcg), in vials of 20 ml (1 ml - 20 drops)).

Indicated: prevention and treatment of chronic obstructive sickness of dysfunctional paths with reversible bronchospasm: bronchial asthma, chronic bronchitis, acceleration or non-erosion of emphysema.

Dosuvannya: in case of hypertension in adults, as well as lithium and latency, it is 1-2 ml of the range, in case of important and severe bronchospasm with stupas, the dose of berodual can be taken up to 2.5-4 ml. In case of trivial and frequent therapy, use 1-2 ml per dose up to 4 times per dose. For children 6-12 years old, in case of bronchial asthma attacks, the recommended dose is to become 0.5-1 ml, or for important attacks, it can be increased to 2-3 ml, and if necessary, bagatorazic inhalations with trivial possibilities, or without interruption of therapy, before failure -1ml for reception up to 4 times for dobu. For children up to 6 years old and up to 22 kg, berodual is inhaled through a nebulizer with 1 speckle per 1 kg of child's weight. It is recommended that the dose of berodual should be discharged by physiological difference until 3-4 ml is injected and inhaled with a stretch of 5-7 minutes. Razchin should be diluted without a priori in front of vikoristannyam, the surplus will be diluted and rinsed out by the nebulizer.

Slid a unique drink of the drug in the eyes, especially in ailments who are sick to glaucoma, which aerosol therapy with berodual is guilty of using a nebulizer with a mouthpiece.

PISLYAMOVA

The author and the group of patients are responsible for the health care workers of Inter-Eton Ltd. "Inter-Eton" is not just a rozpovsyujuvach nebulizer. The main merit of yogo in fact, scho vіn realіzuє Velika medichnu programa of osvіti that navchannya methods nebulayzernoї terapії lіkarіv, medichnih sisters patsієntіv through vidavanі fіrmoyu mіdі Qing Relief i medichnі rekomendatsії, napisanі provіdnimi fahіvtsyami rіznih spetsіalіzatsіy - alergologami, otorіnolarіn Golog, fіtoterapevtami, anestezіologamі- reanimatologists.