Jessica Reyes-AngelGuest
Hiren MuzumdarGuest
Tony TarchichiHost
I guess, so for our kids with neurologic impairment, we've talked a lot about them, and there is usually an element of hypotonia, which is where the cough assist and the chest vest come on.

Help me understand how much or is normal saline nebulized better than humidified air in lubricating...

The surfactant, the thin liquid layer you talked about, is it the fact that there's sodium and chloride in the nebulized normal cellulite that does more help?

But I do think that one thing to, like one point to consider here, it would be also how effective is the delivery of the sodium chloride into the airways when we are talking about humidified air.

The other part that I do think that is going to be important is what substance we are using to humidify the air, because we know that when we use just water that can, if you get a good concentration of water into the airway, that can damage your ciliary cells.

So when we are talking about these benefits of hydration and mucus clearance, we are talking about normal saline or sodium chloride in general.

But in order also for the saline to have effects, we need to make sure that is reaching the airways that we need.

And basically in this sense, the particles of the aerosols or the size of the aerosols is going to be very important to determine to what extent of the airway that is going to reach, if that makes any sense.

So one of the other points to keep in mind is that the efficacy of a face mask to deliver nebulized material into the airway is severely compromised when the mask moves half an inch to an inch away from the face.

So I think in clinical practice, one needs to have some attention to the process of nebulization and making sure that if you think the nebulization is important, that the mask is held flush to the face.

You know, blow-by nebulization makes us feel good, but does nothing for the kid.

Is it safe to say, Jessica, I didn't think there was, or hearing, that there are no head-to-head studies looking at humidified air versus nebulized normal saline? I don't know offhand.

My question is, in which situation are you asking? Is it bronchiolitis? Is it the neurologically impaired? Is it the children with suppurative lung disease? It is the children that are chronic lung disease and ventilator dependent.

Because my expectation is the answer is potentially going to be different for these subsets.

And it's possible that the average child with bronchiolitis is not going to get much benefit from nebulized ceiling, but I don't think we can generalize from that.

think that the key factor here when we talk about the physiologic effects of one or the other one is how the solution is delivered.

And when we are talking about humidification systems, we are talking about vapor.

And when we are talking about nebulizations, we are talking about aerosols.

So this is reaching different parts of the airway, as I was saying before, because we know that aerosols, well, they can reach distal airways, right? Well, vapor.

We know that most of the time when we are using these humidification systems, they are only reaching the upper airway.

I guess, so for our kids with neurologic impairment, we've talked a lot about them, and there is usually an element of hypotonia, which is where the cough assist and the chest vest come on.

Help me understand how much or is normal saline nebulized better than humidified air in lubricating...

The surfactant, the thin liquid layer you talked about, is it the fact that there's sodium and chloride in the nebulized normal cellulite that does more help?

But I do think that one thing to, like one point to consider here, it would be also how effective is the delivery of the sodium chloride into the airways when we are talking about humidified air.

The other part that I do think that is going to be important is what substance we are using to humidify the air, because we know that when we use just water that can, if you get a good concentration of water into the airway, that can damage your ciliary cells.

So when we are talking about these benefits of hydration and mucus clearance, we are talking about normal saline or sodium chloride in general.

But in order also for the saline to have effects, we need to make sure that is reaching the airways that we need.

And basically in this sense, the particles of the aerosols or the size of the aerosols is going to be very important to determine to what extent of the airway that is going to reach, if that makes any sense.

So one of the other points to keep in mind is that the efficacy of a face mask to deliver nebulized material into the airway is severely compromised when the mask moves half an inch to an inch away from the face.

So I think in clinical practice, one needs to have some attention to the process of nebulization and making sure that if you think the nebulization is important, that the mask is held flush to the face.

You know, blow-by nebulization makes us feel good, but does nothing for the kid.

Is it safe to say, Jessica, I didn't think there was, or hearing, that there are no head-to-head studies looking at humidified air versus nebulized normal saline? I don't know offhand.

My question is, in which situation are you asking? Is it bronchiolitis? Is it the neurologically impaired? Is it the children with suppurative lung disease? It is the children that are chronic lung disease and ventilator dependent.

Because my expectation is the answer is potentially going to be different for these subsets.

And it's possible that the average child with bronchiolitis is not going to get much benefit from nebulized ceiling, but I don't think we can generalize from that.

think that the key factor here when we talk about the physiologic effects of one or the other one is how the solution is delivered.

And when we are talking about humidification systems, we are talking about vapor.

And when we are talking about nebulizations, we are talking about aerosols.

So this is reaching different parts of the airway, as I was saying before, because we know that aerosols, well, they can reach distal airways, right? Well, vapor.

We know that most of the time when we are using these humidification systems, they are only reaching the upper airway.
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