Respiratory Care

We determined output characteristics (aerosol size and concentration) as a function of time of the Small Particle Aerosol Generator (SPAG-2, 6000 series), which is supplied for use with ribavirin. METHOD: We measured particle size by cascade impactor and aerosol concentration by spectrophotometric analysis. RESULTS: Aerosol concentrations and particle sizes increased with time, especially during prolonged periods of aerosol generation. Aerosolized drug concentrations in a typical administration hood were within 5% of those emitted by the generator unless the hood was placed in a draft, which caused the loss of significant aerosol. Changes in aerosol concentration and total output occurred when either airflows or reservoir volumes were changed. CONCLUSION: Every effort should be made to sustain maximum respirable concentrations by paying close attention to the aerosol delivery system and its operating conditions.

Textbook selection is based on a number of criteria, one of which may be reading level. METHOD: We searched the literature to find an appropriate method for reading-level assessment and then evaluated 11 respiratory therapy textbooks for average reading-level and internal reading-level variation by the Luiten, Ames, Bradley Variation Method (LAB), which is based on the Fry Readability Model. The LAB is a validated method that employs 12 100-word samples from each book evaluated. We counted syllables and sentences in each sample, computed the mean and standard deviation (SD) of each, multiplied SD by a constant based on t distribution values, and plotted a zone that allows prediction of the average reading level and the internal variation in reading level of 80% of the book. RESULTS: Nine of the books had an average reading level of Grade 17, one was at Grade 16, and one at Grade 14. All books had internal grade-level variations, of as little as 2 years to as much as 10 years. CONCLUSION: This study suggests that some respiratory therapy textbooks in common use are written at a high grade level and have marked grade-level variability within the text. Students may have difficulty comprehending the content of textbooks written at a level beyond their ability. Comprehension may be improved if students are required to master terminology prior to respiratory therapy classwork and if they are required to outline and/or rewrite reading assignments. Authors who are writing introductory texts should use shorter sentences and simpler language wherever possible.

We report a patient who unknowingly aspirated denture material in association with a motorcycle accident in 1974. After a number of hospital admissions over 10 years for recurrent right-lower-lobe pneumonia, in 1984 he underwent rigid bronchoscopy that revealed the foreign body. The radiolucent nature of the denture material may have accounted for several earlier failures to detect it. Recurrent pneumonia in the same lung segment, especially in a younger person without underlying disease, should arouse suspicion of foreign-body aspiration.

These guidelines were developed by the American Association for Respiratory Care in response to a request by the Health Care Financing Administration for professional assistance in defining criteria for establishment of demonstration units for management of chronic ventilator-dependent patients in hospitals. Although the exact method by which these demonstration units (3 to 5 in number) will be selected has not been announced, these guidelines will have an important role in assuring that appropriate sites are chosen and that patient selection and data collection are adequate to document the possible benefits of such units.