Preventive Care in Nursing and Midwifery

en Effect of Jet Nebulizer Placement Relative to the Heat and Moisture Exchange (HME) Filter on Pulmonary Parameters in Mechanically Ventilated Adults: A Randomized, Double-Blind Controlled Trial Nursing Orginal research <div style="text-align: justify;">Background: Heat and moisture exchanger (HME) filters are essential for mechanically ventilated patients but can hinder aerosol delivery. Objectives: This study compared jet nebulizer placement positions relative to the HME filter on pulmonary parameters. Methods: This double-blind randomized controlled trial assessed 86 patients for eligibility. After excluding 13, 73 were randomized into two groups: the intervention group (n = 36), where the nebulizer was placed between the patient and the HME filter, and the control group (n = 37), where it was placed between the ventilator and the HME. During the trial, 3 patients died (intervention: 1, control: 2), resulting in a final analysis of 70 patients (35 per group). Parameters were measured at baseline and at 90 minutes after each of four bronchodilator doses administered over 24 hours. Data analysis included repeated measures ANOVA via SPSS v.22. Results: Significant within-group time effects were found for mean airway pressure (MAP), SpO₂, lung compliance (Cst), and airway resistance (Raw) (p < 0.05). Tidal volume (VT) and minute ventilation (MV) showed no significant temporal changes (p > 0.05). The time×group interaction was significant only for Raw and SpO₂ (p < 0.05). Between-group analysis revealed significant differences in VT, MAP, SpO₂, Raw, and MV (p < 0.05), but not for Cst (p = 0.222). Conclusion: Nebulizer placement relative to the HME filter affects temporal changes in Raw and SpO₂. Considering small-to-moderate effect sizes, differences are primarily physiological; thus, placement should be guided by clinical status and specific protocols.  </div> Nebulizers, Heat and Moisture Exchangers, Airway Resistance, Lung Compliance, Mechanical Ventilation. 60 69 http://nmcjournal.zums.ac.ir/browse.php?a_code=A-10-1053-1&slc_lang=en&sid=1 Zahra Khezerlou Zahrakhezerloo8@gmail.com 0000-0002-8893-5251 No Medical Surgical Nursing Department, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran Akram Khediri a.khediri@gmail.com 0000-0002-1234-5678 No Emergency and Critical Care Nursing Department, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran Farhad Ramezani-Badr Ramezanibadr@gmail.com 0000-0001-9576-5193 Yes Emergency and Critical Care Nursing Department, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran Mohammad Reza Din Mohammadi mdinmohammadi@zums.ac.ir 0000-0003-4293-973X No Emergency and Critical Care Nursing Department, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran Samad Ghodrati samad.ghodrati@zums.ac.ir 0000-0002-9597-0493 No Pulmonology Department, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran Mahtab Aligholipour aligholipourmahtab@gmail.com 0000-0002-4829-0524 No Emergency and Critical Care Nursing Department, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran