Aerosol Delivery of Antimicrobial Agents During Mechanical Ventilation: Current Practice and Perspectives

Abstract

Critically ill patients, who develop ventilator-associated pneumonia during prolonged mechanical ventilation, often require antimicrobial agents administered through the endotracheal or the tracheotomy tube. The delivery of antibiotics via the respiratory tract has been established over the past years as an alternative route in order to deliver high concentrations of antimicrobial agents directly to the lungs and avoid systemic toxicity. Since the only formal indications for inhaled/aerosolized antimicrobial agents is for patients suffering from cystic fibrosis, consequently the majority of research and published studies concerns this group of patients. Newer devices and new antibiotic formulations are currently off-label used in ambulatory cystic fibrosis patients whereas similar data for the mechanically ventilated patients do not yet exist.

Nebulization of single-chain tissue-type and single-chain urokinase plasminogen activator for treatment of inhalational smoke-induced acute lung injury

“…The EZ Breathe® nebulizer device is a passive type vibrating mesh nebulizer, while the Aeroneb® Pro nebulizer device is an active vibrating mesh device. Both types of VMNs produce droplets within the optimum droplet size range of 3–5 μm, which are sized for deposition in the tracheobronchial tree (78). The results confirmed the nebulization efficiency of the VMNs in terms of aerosol droplet size, which correlates with deposition characteristics (79).…”

Terapia Inhalatoria en Pacientes Que Reciben Ventilación Mecánica

“…Tabla 9. Medicamentos inhalados que se administran a pacientes en ventilación mecánica (13,44,(64)(65)(66)(67)(68). Tabla 7.…”

Vibrating Mesh Nebulisers – Can Greater Drug Delivery to the Airways and Lungs Improve Respiratory Outcomes?

“…MV is used for the most seriously ill and critical patients, but more recently there has been a general trend towards less invasive means of ventilatory support for many such patients. [54][55][56] Aerosol therapy is frequently introduced into mechanical breathing circuits and is used by over 95% of intensivists, mostly for bronchodilator, antibiotic and steroid administration, 51,[57][58][59] and less frequently for anticoagulants, diuretics, mucoactive agents, prostacyclins and surfactants. 46 One recent in vitro study compared the performance of four different nebulisers; the SideStream ® Disposable JN (Philips Healthcare Limited, Guildford, Surrey, UK), the Multisonic ® InfraControl UN (Flores medical GmbH, Probstzella, Germany), the Aerogen ® Pro VMN and the Aerogen ® Solo VMN (Aerogen, Dangan, Galway, Ireland) to deliver salbutamol in a model MV system.…”