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LETTER TO EDITOR
Year : 2019  |  Volume : 36  |  Issue : 6  |  Page : 567-568  

Use of Venturi to prevent desaturation during nebulization


1 Department of Superspeciality Anaesthesia, RIMS, Ranchi, Jharkhand, India
2 Department of Oncoanaesthesia and Palliative Medicine, NCI, AIIMS, Jhajjar, Haryana, India
3 Department of Oncoanaesthesia and Palliative Medicine, Dr. BR Ambedkar IRCH, AIIMS, New Delhi, India

Date of Web Publication31-Oct-2019

Correspondence Address:
Sachidanand Jee Bharti
Department of Oncoanaesthesia and Palliative Medicine, Dr. BR Ambedkar IRCH, AIIMS, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/lungindia.lungindia_96_19

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How to cite this article:
Hoda W, Ratre BK, Bharti SJ. Use of Venturi to prevent desaturation during nebulization. Lung India 2019;36:567-8

How to cite this URL:
Hoda W, Ratre BK, Bharti SJ. Use of Venturi to prevent desaturation during nebulization. Lung India [serial online] 2019 [cited 2019 Nov 17];36:567-8. Available from: http://www.lungindia.com/text.asp?2019/36/6/567/270093



Sir,

Nebulization is the delivery of saline or drugs in the form of small droplets to the distal lung, which is a common practice in intensive care unit (ICU).[1] It is done with the help of nebulizers which are connected to the inspiratory limb of breathing circuit either in mechanically or spontaneously ventilated patients. Spontaneously breathing patients who are admitted in ICU also need oxygen supplementation. Nebulization in such patients needs attention with careful monitoring of vitals, airway pressure, and oxygen saturation to prevent any desaturation or other adverse events.[2] During conventional nebulization, even with oxygen flow rate of 6–8 L/min, there is a fall in oxygen saturation. In some cases, if not corrected, it may lead to severe hypoxemia and hemodynamic instability. Therefore, we introduce a noble technique using a Venturi to prevent such events. Venturi is considered a high-flow oxygen therapy device. The final assembly with Venturi is shown in [Figure 1]. It is connected between the nebulizer and the oxygen source. Different types of Venturi device (color coded) can be used according to the need. The assembly increases the flow, which helps in the delivery of high FiO2 preventing desaturation.
Figure 1: Venturi–nebulizer assembly; Venturi is attached between the nebulizer apparatus and oxygen source

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In literature, there are numerous other advantages of high-flow therapy. Venturi is commonly used in the hospital setting to deliver controlled percentages of oxygen.[3] During acute distress, the ventilatory demand increases to 30 L/min to 120 L/min. Normal quite breathing inspiratory flow is 15 L/min. Venturi nebulizer creates inspiratory flow of 60 L/min. By increasing inspiratory flow demand, it also gives a subjective feeling of satisfaction with an objective decrease in tachypnea and thereby improves saturation.[4] As it is a high-flow delivery device, it creates positive pressure in nasopharynx which could act like positive end expirarory pressure (PEEP) to prevent alveolar collapse at the end of expiration. Hence, it helps improve ventilation and perfusion ratio, minimizing shunting.[5]


   Conclusion Top


In ICU settings, patients are oxygen dependent due to intrinsic lung pathology or because of weakness in respiratory musculature. Many a time, desaturation may lead to suboptimal respiratory care and premature cessation of nebulization. This technique of using Venturi system with nebulization effectively takes care of the desaturation and improves care in ICU.

Acknowledgments

We would like to thank the ICU team along with the physiotherapist colleague working with us during the management of such cases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
O'Doherty MJ, Thomas SH. Nebuliser therapy in the intensive care unit. Thorax1997;52 Suppl 2:S56-9.  Back to cited text no. 1
    
2.
Dhanani J, Fraser JF, Chan HK, Rello J, Cohen J, Roberts JA, et al. Fundamentals of aerosol therapy in critical care. Crit Care 2016;20:269.  Back to cited text no. 2
    
3.
Pepperell JC, Fraser C, Mcclue G. The use of Venturi masks with oxygen concentrators. Thorax 2011;201054c: 139.  Back to cited text no. 3
    
4.
L'Her E, Deye N, Lellouche F, Taille S, Demoule A, Fraticelli A, et al. Physiologic effects of noninvasive ventilation during acute lung injury. Am J Respir Crit Care Med 2005;172:1112-8.  Back to cited text no. 4
    
5.
Parke R, McGuinness S, Eccleston M. Nasal high-flow therapy delivers low level positive airway pressure. Br J Anaesth 2009;103:886-90.  Back to cited text no. 5
    


    Figures

  [Figure 1]



 

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