Aerosol therapy in intensive and intermediate care units: prospective observation of 2808 critically ill patients

Ehrmann, Stéphan; Roche-Campo, Ferrán; Bodet-Contentin, Laëtitia; Razazi, Keyvan; Dugernier, Jonathan; Trenado-Alvarez, J; Donzeau, A; Vermeulen, François; Thévoz, David; Papanikolaou, Metaxia; Edelson, Antoine; Yoshido, Héctor León; Piquilloud, Lise; Lakhal, Karim; Lopes, Carlos; Vicent, Carlos; Desachy, Arnaud; Apiou-Sbirlea, Gabriela; Isabey, Daniel; Brochard, Laurent

doi:10.1007/s00134-015-4114-5

Cited by 71 publications

(84 citation statements)

References 40 publications

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“…Aerosolized drugs are currently not limited to bronchodilators, but also include glucocorticoids, mucolytics, and antibiotics. In view of the value of many of these drugs, it is necessary to prolong nebulization time in order to minimize the amount of residual drug solution [4]. The factor that ultimately determines the clinical effectiveness of aerosol inhalation is the aerosol deposition rate, which is affected by the diameter of the aerosol particles and the delivery efficiency.…”

Section: Discussionmentioning

confidence: 99%

“…Most patients receiving noninvasive ventilation for respiratory failure also require aerosol inhalation of drugs such as bronchodilators, glucocorticoids, mucolytics, and antibiotics [4]. Research has found aerosol inhalation therapy in conjunction with noninvasive ventilation to be a more effective method of drug delivery than conventional nebulization (in between noninvasive positive pressure ventilation sessions) [5].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Which Nebulizer Position Should Be Avoided? An Extended Study of Aerosol Delivery and Ventilator Performance during Noninvasive Positive Pressure Ventilation

Peng¹,

Dai²,

Hu³

et al. 2017

Respiration

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Background: Research on the effect of nebulizer location on aerosol delivery during noninvasive ventilation has reached inconsistent conclusions. Objective: To investigate the effects of nebulizer position on aerosol delivery efficiency and ventilator performance during noninvasive ventilation. Methods: The Active Servo Lung 5000 respiratory simulation system (ASL5000) was used to simulate a COPD patient. The noninvasive ventilator was set to the spontaneous breathing mode. Six nebulizer positions, 2 exhalation valve types (single-arch exhalation port and whisper swivel), 4 combinations of inspiratory and expiratory pressure, and 2 respiratory rates were used. Results: Significant differences between nebulizer positions existed in aerosol delivery (p < 0.05). Aerosol delivery efficiency was lower for nebulizer locations on either side of the exhalation valve and next to the ventilator outlet. When the nebulizer was located between the exhalation valve and the simulated lung, increased inspiratory pressure increased and increased expiratory pressure decreased delivery efficiency (both p < 0.05). When the nebulization device was located between the exhalation valve and the ventilator, no obvious trend was observed. Compared to baseline, nebulization lowered the air leakage volume displayed on the ventilator. There were no differences in ventilator performance between different nebulizer positions. Conclusions: The closer the nebulizer was to the exhalation valves or ventilator, the lower the aerosol delivery efficiency. Nebulizer position had little clinically significant effect on ventilator performance.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Which Nebulizer Position Should Be Avoided? An Extended Study of Aerosol Delivery and Ventilator Performance during Noninvasive Positive Pressure Ventilation

Peng¹,

Dai²,

Hu³

et al. 2017

Respiration

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“…A follow-up study by the same group utilized a cross-sectional point prevalence study over 14 days in 81 ICUs in 22 countries including 2,808 patients (283). A total of 678 (24%) patients received at least one inhaled medication during the study period, about half of whom were patients who were intubated.…”

Section: Nosocomial Pneumoniamentioning

confidence: 99%

Inhaled Antibiotics for Gram-Negative Respiratory Infections

et al. 2016

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SUMMARYGram-negative organisms comprise a large portion of the pathogens responsible for lower respiratory tract infections, especially those that are nosocomially acquired, and the rate of antibiotic resistance among these organisms continues to rise. Systemically administered antibiotics used to treat these infections often have poor penetration into the lung parenchyma and narrow therapeutic windows between efficacy and toxicity. The use of inhaled antibiotics allows for maximization of target site concentrations and optimization of pharmacokinetic/pharmacodynamic indices while minimizing systemic exposure and toxicity. This review is a comprehensive discussion of formulation and drug delivery aspects,in vitroand microbiological considerations, pharmacokinetics, and clinical outcomes with inhaled antibiotics as they apply to disease states other than cystic fibrosis. In reviewing the literature surrounding the use of inhaled antibiotics, we also highlight the complexities related to this route of administration and the shortcomings in the available evidence. The lack of novel anti-Gram-negative antibiotics in the developmental pipeline will encourage the innovative use of our existing agents, and the inhaled route is one that deserves to be further studied and adopted in the clinical arena.

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“…Many drugs are administered as aerosol [2] using nebulizers for treatment of intubated mechanically ventilated patients [3].…”

Section: Introductionmentioning

confidence: 99%

Stability of commonly nebulized drugs in heated and humid condition

Saeed¹,

Abdelrahim²,

Fink³

2018

Med-Science

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Placement of nebulizer prior to heated humidifier has been reported to improve efficiency of aerosol delivery during ventilator support. Drugs nebulized in this position must travel through humidifier, rainout in reservoir and may be subjected to extended periods of heat up to 50°C. Toxic degradation may develop, posing potential risk to patient. The aim of this study was to evaluate chemical stability of commonly inhaled drugs administered to mechanically ventilated patients subjected to extended period of 50°C. Formulations of 8 comonly inhaled drugs were diluted to 50 mL total volume in water and exposed to 50oC for 7 days to simulate effect of heat in humidifier. High Performance Liquid Chromatography (HPLC) was performed before and after heating to determine drug stability and degradation. Drug integrity, color or pH changes were noted. Epinephrine, levalbuterol, tobramycin and colistin demonstrated>10% reduction in concentration but only acetylcysteine had additional peaks in HPLC chromatogram demonstrating potential degradation and possible production of by product. Changes in color were observed with epinephrine and acetylcysteine. All drugs retained their integrity after subjecting them to 50oC for 7 days except acetylcysteine. Acetylcysteine changed color and had new peak in HPLC chromatogram. Color change with epinephrine was not associated with any new peak in HPLC chromatogram. Further studies should determine whether acetylcysteine changes would result in any off gassing of vapor that might harm the patient.

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Aerosol therapy in intensive and intermediate care units: prospective observation of 2808 critically ill patients

Abstract: Aerosol therapy concerns every fourth critically ill patient and one-fifth of ventilated patients.

Cited by 71 publications

References 40 publications

Which Nebulizer Position Should Be Avoided? An Extended Study of Aerosol Delivery and Ventilator Performance during Noninvasive Positive Pressure Ventilation

Which Nebulizer Position Should Be Avoided? An Extended Study of Aerosol Delivery and Ventilator Performance during Noninvasive Positive Pressure Ventilation

Inhaled Antibiotics for Gram-Negative Respiratory Infections

Stability of commonly nebulized drugs in heated and humid condition

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