Biomedical subjects

James B Fink

Publications and source records attributed to James B Fink.

4 recordsLinked to original sources

PubMed2003

The delivery of inhaled medication to the young child.

The effective and efficient delivery of aerosol medications involves physician factors (correct diagnosis and correct prescription of appropriate medications), device factors, and patient factors. For nearly all infants and children, the authors administer asthma medications either using a pMDI with a valved holding chamber or a DPI. Regardless of the device chosen, parent and patient education is critical for the appropriate use of the device, and frequent reinforcement of the educational message will often improve adherence and correct use.

Administration, Inhalation↗

PubMed2002

Positioning versus postural drainage.

For the past 70 years positioning and postural drainage have played an important role in increasing lung volumes, perfusion, oxygenation and mobilization of secretions. While gravity is not a primary mechanism for normal secretion clearance, it plays a major role in depth and pattern of ventilation, perfusion, and lymphatic drainage. Changing patient position, or turning patients on a regular basis, is a powerful tool in maintaining lung health in a broad range of patients. In contrast, postural drainage requires considerable investment of time, and has been shown to have limited benefit in most patients. Postural drainage has been shown to improve mobilization of secretions in patients with cystic fibrosis as well as patients who produce, and have difficulty clearing, large quantities of sputum. The benefits of postural drainage appear technique-dependent, requiring sufficient drainage time (3 - 15 min) for each position drained. The evidence does not support the use of vibration and percussion independent of active postural drainage. Exercise offers benefit in secretion clearance, which increases when combined with a program of postural drainage. In conclusion, routine turning, mobilization and exercise is important to maintain lung health in all patients, while postural drainage, properly applied, has been shown to improve secretion clearance in a relatively narrow range of patients with cystic fibrosis and excessive sputum production.

Contraindications↗

PubMed2002

Positive pressure techniques for airway clearance.

Positive airway pressure (PAP) has been used since the 1930s to improve oxygenation, increase lung volumes and reduce venous return. More recently, PAP has been identified as an effective method of splinting airway during expiration, improving collateral ventilation, increasing response to inhaled bronchodilators, and aiding secretion clearance in patients with cystic fibrosis and chronic bronchitis. A range of devices, administration techniques, and evidence supporting their clinical use is explored, suggesting that PAP is equivalent to postural drainage in the clearance of secretions. PAP produced by threshold and fixed orifice resistors generate different characteristic flow, and airway and esophageal pressure patterns that may contribute to different physiologic effects. Further clinical studies are required to better understand the effects of these differences.

Aerosols↗

PubMed2002

High-frequency oscillation of the airway and chest wall.

High-frequency oscillation (HFO), applied to either the airway or chest wall, has been associated with changes in sputum attributes and clearance. The evolution of evidence, both in vitro and in vivo, supporting the use of HFO is reviewed. Devices that apply HFO to the airway range from the relatively simple mechanical Flutter and Acapella devices to the more complex Percussionaire Intrapercussive Ventilators. and the Hayek Oscillator are designed to provide high-frequency chest wall compression. Operation and use of these devices are described with examples of differentiation of device types by characterization of flows, and airway and esophageal pressures. Although HFO devices span a broad range of costs, they provide a reasonable therapeutic option to support secretion clearance for patients with cystic fibrosis.

Cystic Fibrosis↗