ABSTRACT
Inhalation of aerosolised medications are the mainstay of treatment for a number of chronic lung diseases and have several advantages over systemically-administered medications. These include more rapid onset of action for drugs such as ß-adrenergic agonists when compared with oral medication, high luminal doses for inhaled antibiotics when used to treat endobronchial infection, and an improved therapeutic index compared with systemic delivery for these and other classes of drugs such as corticosteroids. The use of aerosolised drugs to treat patients whose tracheas are intubated is less well established, in part because systemic delivery via the intravenous route can be a simpler alternative for many drugs. Consequently, research in this area is largely limited to a number of in vitro studies and very few clinical trials. Unfortunately, a lack of focus in this area has resulted in a number of practices which at best are ineffective, and at worst dangerous for the patient. Although there have been some attempts to re-invigorate research in order to improve delivery systems, current devices are, to a great extent, based on long-standing technology developed more than 50 years ago. In this review, we explore current knowledge and provide guidance as to when and how the inhaled route may be of value when treating patients whose tracheas are intubated, and we set out the challenges facing those attempting to advance the topic. We conclude by reviewing current areas of interest that may lead to more effective and widespread use of aerosols in the treatment of intubated patients.
Subject(s)
Aerosols , Noninvasive Ventilation/methods , Pharmaceutical Preparations/administration & dosage , Respiration, Artificial/methods , Administration, Inhalation , Adolescent , Child , Child, Preschool , Humans , Infant , Nebulizers and VaporizersABSTRACT
A fatal accident involving concentrated hydrofluoric acid in a palynological laboratory is described. Similar deaths due to dermal exposure to concentrated hydrofluoric acid have been reported in the literature. It is evident that rigorous control measures including proper personal protective equipment and first aid are of utmost importance in the prevention of death and injury when handling hydrofluoric acid. Possible factors that may have contributed to the accident are reviewed.
Subject(s)
Accidents, Occupational , Burns, Chemical/etiology , Fluorides/toxicity , Geology , Hydrofluoric Acid/toxicity , Laboratories , Adult , Fatal Outcome , Geological Phenomena , Humans , Male , Multiple Organ FailureABSTRACT
This study examined the effects of a chronic maternal infusion of epinephrine on development of the rat embryo. Epinephrine was infused during days 1 to 8, 8 to 15, or 15 to 22 of pregnancy to cover periods of implantation, embryogenesis, and rapid fetal growth, respectively. Infusions were accomplished with osmotic minipumps to avoid repeated handling stress. The infusion rate of 0.125 micrograms/min elevated resting plasma concentrations of epinephrine in nonpregnant rats by about sevenfold (from 0.28 to 1.98 ng/ml). Under these conditions, epinephrine did not affect the number of rats maintaining pregnancy, their litter size, or the numbers of resorptions, fetal deaths, and malformations. Fetal and placental weights were unaffected except for a slight trend for fetal weight to be depressed in larger litters of rats treated during days 15 to 22. It seems that the rat embryo is resistant to elevations of epinephrine concentrations equivalent to those observed under mild to severe stress conditions.
