Practice pattern of aerosol therapy among patients undergoing mechanical ventilation in mainland China: A web-based survey involving 447 hospitals

Abstract

Background and objective Aerosol therapies are widely used for mechanically ventilated patients. However, the practice pattern of aerosol therapy in mainland China remains unknown. This study aimed to determine the current practice of aerosol therapy in mainland China. Methods A web-based survey was conducted by the China Union of Respiratory Care (CURC) from August 2018 to January 2019. The survey was disseminated via Email or WeChat to members of CURC. A questionnaire comprising 16 questions related to hospital information and 12 questions related to the practice of aerosol therapy. Latent class analysis was employed to identify the distinct classes of aerosol therapy practice. Main results A total of 693 valid questionnaires were returned by respiratory care practitioners from 447 hospitals. Most of the practitioners used aerosol therapy for both invasive mechanical ventilation (90.8%) and non-invasive mechanical ventilation (91.3%). Practitioners from tertiary care centers were more likely to use aerosol therapy compared with those from non-tertiary care centers (91.9% vs. 85.4%, respectively; p = 0.035). The most commonly used drugs for aerosol therapy were bronchodilators (64.8%) followed by mucolytic agents (44.2%), topical corticosteroids (43.4%) and antibiotics (16.5%). The ultrasonic nebulizer (48.3%) was the most commonly used followed by the jet nebulizer (39.2%), the metered dose inhaler (15.4%) and the vibrating mesh nebulizer (14.6%). Six latent classes were identified via latent class analysis. Class 1 was characterized by the aggressive use of aerosol therapy without a standard protocol, while class 3 was characterized by the absence of aerosol therapy. Conclusions Substantial heterogeneity among institutions with regard to the use of aerosol therapy was noted. The implementation of aerosol therapy during mechanical ventilation was inconsistent in light of recent practice guidelines. Additional efforts by the CURC to improve the implementation of aerosol therapy in mainland China are warranted.

Airway Care Interventions for Invasively Ventilated Critically Ill Adults—A Dutch National Survey

“…Nebulization of mucoactive agents is thought to reduce accumulation of thick and sticky airway secretions [ 4 ]. Mucoactive agents are often used in combination with bronchodilators to enhance mobilization of mucus by opening the airways [ 5 , 6 , 7 ]. Manual hyperinflation [ 8 , 9 , 10 ] or mechanical in–exsufflation (MI–E), (commonly referred to as cough assist) [ 8 , 11 , 12 ], may be helpful techniques in mobilizing airway secretions from smaller to larger airways, where it can be removed using suctioning.…”

“…Nebulization of mucoactive agents is thought to reduce accumulation of thick and sticky airway secretions [4]. Mucoactive agents are often used in combination with bronchodilators to enhance mobilization of mucus by opening the airways [5][6][7].…”

Drug‐naïve first‐episode schizophrenia spectrum disorders: Pharmacological treatment practices in inpatient units in Hunan Province, China

“…Moreover, such care is unequally distributed across different levels of hospitals. Tertiary hospitals are the best equipped and provide advanced medical investigation and treatment to referrals from primary and secondary hospitals (Zhang et al, 2019 ).…”

Aerosol delivery via invasive ventilation: a narrative review

“…While as much as 30% of aerosols are typically inhaled, a greater proportion of administered aerosols will be exhausted, leading to concerns regarding secondhand exposure of healthcare providers and families to medical aerosols (67). However, surveys reported that the usage rate of protective filters on the expiratory limb of ventilator circuits was only 24-40% (68,69).…”

“…Most patients (82%) received bronchodilators, followed by corticosteroids (13%), anti-infectious drugs (5%, primarily colistin), and mucolytics (3%, primarily acetylcysteine), and 38% of patients received >2 medications. Another recent survey conducted in China revealed bronchodilators (64.8%) were the most administered drugs, followed by mucolytic agents (44.2%), corticosteroids (43.4%), and antibiotics (16.5%), using USNs (48.3%), JNs (39.2%), VMNs (14.6%), and pMDIs (15.4%) (69). The discrepancies between these two studies could be attributed to physician training, drug/device availability, and insurance system coverage.…”