Inhalation Techniques Used in Patients with Respiratory Failure Treated with Noninvasive Mechanical Ventilation

Rzepka-Wrona, Patrycja; Skoczyński, Szymon; Wrona, Dawid; Barczyk, Adam

doi:10.1155/2018/8959370

Cited by 15 publications

(15 citation statements)

References 74 publications

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“…This means that not only dose but the method of delivery also becomes a limiting factor. Once the dose is finalized and accounted for, the delivery of the aerosolized surfactant can be achieved via different approaches in and out of the ICU such as, but not limited to, non-invasive nebulization, CPAP, and NIV; and, if required, using invasive intubated ventilation (Shah, 2011;Willson, 2015;Dhand, 2017;Rzepka-Wrona et al, 2018). Although these clinical techniques are well known and employed, targeted nanocarriers capable of self-demicellization may provide the strategy to cover or even remove the coating cost.…”

Section: The Hypothesis and The Discussionmentioning

confidence: 99%

Co-aerosolized Pulmonary Surfactant and Ambroxol for COVID-19 ARDS Intervention: What Are We Waiting for?

Kumar

2020

Front. Bioeng. Biotechnol.

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After more than 225 days of the first reports of the novel coronavirus from China, COVID-19 pandemic is still on surge. The search for an effective and efficient therapeutic and pharmaceutical intervention is as important and urgent now as it was on Day 1. Majority of the efforts in this direction are toward finding small molecule interventions via repurposing or redirecting the therapeutic approaches. This hypothesis proposes a physical intervention approach directed toward rescuing the complex lung pathology observed in COVID-19 related acute respiratory distress syndrome (CARDS). The loss of content as well as the synthesis and turnover of the surfactant in ARDS has been termed as a "collateral damage." A synergistic, early stage, cost-effective, pharmaceutically viable, safe, and immediately available solution is hence required. The effectiveness of exogenous surfactant treatment in ARDS has been marred with several limitations as pointed out in various clinical trials and require revised protocols related to surfactant dose and mode of delivery. This hypothesis proposes aerosolized surfactant delivery taking the optimal dosing and coating costs into account along with co-delivery of ambroxol to provide synergistic benefits. Ambroxol is reported to have anti-inflammatory,-oxidant,-viral, and-bacterial activities and has a direct impact on the production and secretion of the surfactant from the alveolar Type 2 cells. If aerosolized, atomized, or nebulized in the form of ambroxol-loaded phospholipid nanovesicles at the early stages of ARDS, depleted surfactant levels may be reinstated and surfactant turnover can be initiated and maintained. The ability to deliver both the components in aerosolized-nebulized form may have a huge impact on alleviating the healthcare burden in low resource settings where the availability of ventilators is limited. In conclusion, the surfactant-ambroxol co-aerosolized intervention approach hypothesized here has implications reaching to clinical and pharmaceutical translation worldwide.

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Section: The Hypothesis and The Discussionmentioning

confidence: 99%

Co-aerosolized Pulmonary Surfactant and Ambroxol for COVID-19 ARDS Intervention: What Are We Waiting for?

Kumar

2020

Front. Bioeng. Biotechnol.

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“…This can be accomplished by connecting a nebulizer to a single-limb circuit close to the patient and, when possible, utilizing low inspiratory pressures and prolonged inspiratory time to aid in aerosol deposition. 42 Such an administration method could also be employed for most situations when interruption of the ventilator circuit is not feasible.…”

Section: Discussionmentioning

confidence: 99%

Nebulized Heparin for Adult Patients With Smoke Inhalation Injury: A Review of the Literature

Phelps

Olson

Patel

et al. 2020

Journal of Pharmacy Technology

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Objective: To review the clinical effects of nebulized heparin and N-acetylcysteine (NAC) in patients with smoke inhalation injury (IHI) and provide recommendations for use. Data Sources: A search of PubMed, MEDLINE, and Scopus databases was completed from database inception through April 15, 2020, using terms: heparin, acetylcysteine, smoke inhalation injury, and burn injury. Study Selection and Data Extraction: All studies pertaining to efficacy and safety of nebulized heparin and/or NAC for IHI in adult patients were evaluated. Reference lists were reviewed for additional publications. Nonhuman studies, non-English, and case report publications were excluded. Data Synthesis: Eight studies were included. Four demonstrated positive outcomes, 3 demonstrated no benefit or possible harm, and 1 assessed safety. Supporting trials treated patients within 48 hours of injury with 10 000 units of nebulized heparin with NAC for 7 days or until extubation. Two trials with negative findings treated patients within 72 hours, or unspecified, with 5000 units of nebulized heparin with NAC for 7 days, while the third used 25 000 units within 36 hours but was grossly underpowered for analysis. Clinical findings include reduced duration of mechanical ventilation and improved lung function with possible increase risk of pneumonia and no evidence of increased bleeding risk. Conclusions: Nebulized heparin may improve oxygenation and reduce duration of mechanical ventilation in IHI. If nebulized heparin is used, 10 000 units every 4 hours alternating with NAC and albuterol at 4-hour intervals is recommended. Sterile technique should be emphasized. Monitoring for bronchospasm or new-onset pneumonia should be considered.

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“…4 Similar techniques can be used for bronchodilator administration while receiving non-invasive ventilation (NIV). 5…”

Section: Administration Of Metered Dose Inhalers (Mdis) Instead Of Nebulizationmentioning

confidence: 99%

Pharmacy Interventions to Minimize Use of Personnel Protective Equipment and Limiting Caregiver Exposure During Coronavirus Disease 2019

Hisham¹,

Faisal

John

et al. 2020

Hosp Pharm

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Inhalation Techniques Used in Patients with Respiratory Failure Treated with Noninvasive Mechanical Ventilation

Cited by 15 publications

References 74 publications

Co-aerosolized Pulmonary Surfactant and Ambroxol for COVID-19 ARDS Intervention: What Are We Waiting for?

Co-aerosolized Pulmonary Surfactant and Ambroxol for COVID-19 ARDS Intervention: What Are We Waiting for?

Nebulized Heparin for Adult Patients With Smoke Inhalation Injury: A Review of the Literature

Pharmacy Interventions to Minimize Use of Personnel Protective Equipment and Limiting Caregiver Exposure During Coronavirus Disease 2019

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