ATS POSTER (Presented in Toronto, 2009)
A just-completed study using a toddler model shows the Oxyphone to be better than a tight-fitting mask at delivering aerosolized albuterol. (Geller 2)
There is a definite logic to the Oxyphone pediatric nebulizer phone. It's development is based on several well known factors in pediatric pulmonology.
Most children do not like the mask. It increases their fear in an already frightening situation. Anxiety, medication effects and the precipitating respiratory problem all combine to increase tachypnea and tachycardia. Stridor and wheezing will both increase in anxious children.
Children, especially 2-6 year olds, have the physical strength to make giving a nebulized treatment almost impossible without brute force. They are not likely to submit to our logic or parental threats. This physical restraint and increased crying creates increased stress on the child and more parental anxiety.
Crying changes several parameters of respiratory activity. The first is to prolong the expiratory phase which forces aerosol out of the mask, increasing the dead space. The second is a shortened inspiratory phase. These factors combine to decrease droplet depostion to 25% in a crying child compared to that of normal respiration. (Berlinski)
A recent study has shown that using a mask for blow-by is less effective than blow-by with a corrugated tube (Geller 1) Geller also states "...blowby with an extension tube (but not with a mask) is an acceptable alternative to a close-fitting mask, especially if it prevents fussiness of the child."(Geller 1)
Blow-by is the way the majority of nebulizer treatments are given to this age group. This requires a Health Care Provider (HCP) to maintain continuous presence during the treatment. The parent, or many times another HCP must hold the child. The nebulizer output must blow at the child's mouth and nose to increase the local concentration of the medication. If the child moves, the HCP delivering the treatment must follow with the nebulizer. The effective breathable concentration drops dramatically while the HCP "catches up" with the child.
The Oxyphone is held to the child's ear. The mouthpiece directs a continuous flow of nebulized medication to the nose and mouth area. Since the Oxyphone moves when the child moves, there is no loss in concentration at the oro-nasal region. Even if the child moves constantly, the local concentration continues as long as the Oxyphone is held to the child's ear.
Most children enjoy their treatment with the Oxyphone. Generally they do not have to be held, thereby freeing up a member of the treatment team. The cooperative child can hold the Oxyphone and the parent can easily monitor the flow of medication by watching the mouthpiece. Gentle redirection can be accomplished as needed by either the parent or monitoring HCP.
Studies have shown that a nebulizer may function at less than 50% when held at an angle of 45 degrees. The Oxyphone has a built-in angle of 45 degrees to the vertical plane allowing it to be held upright while holding it like a phone. The rotating connector allows the Oxyphone to be used with the child laying on his side.
A quiet child will have an optimal respiratory pattern to inhale aerosolized medication. The Oxyphone can provide a calming effect because of the music and familiar shape.