Use of a Shared Canister Protocol for the Delivery of Metered-Dose Inhalers in Mechanically Ventilated Subjects

Abstract

BACKGROUND: Mechanically ventilated patients often need bronchodilators administered via a metered-dose inhaler (MDI).similar between the shared canister and single-patient canister groups. We did not observe clinically important differences for ventilator-associated events between study groups in our logistic regression analysis (P ‫؍‬ .07). There was a savings of $217/subject in the shared canister group due to the use of 299 fewer MDIs. CONCLUSIONS: Our study found that shared canister MDI therapy compared with single-patient MDI use was associated with a significant cost savings and similar rates of VAP, hospital mortality, and length of stay but a greater prevalence of ventilatorassociated events. This finding suggests that shared canister delivery of MDIs may be a cost-effective practice in mechanically ventilated patients. Based on our findings, further studies examining the overall safety of shared canister use in mechanically ventilated patients seem warranted before recommending their routine use. (ClinicalTrials.gov registration NCT01935388.)

Managing the Rising Costs and High Drug Expenditures in Critical Care Pharmacy Practice

“…Furthermore, a prospective trial demonstrated that a shared canister protocol for the delivery of MDIs was associated with a $40,000 cost savings without any differences in ventilator days, ventilator-associated pneumonias, or hospital mortality. 55 Although ventilator-associated events were noted to be more prevalent in the shared canister arm compared with the standard care arm, these findings are unclear because ventilator-associated events are more often used for surveillance at the population level rather than at the bedside. Nonetheless, although this approach may reduce waste, additional safety data on this approach as well as established infection control practices are needed prior to widespread implementation.…”

“…Nonetheless, although this approach may reduce waste, additional safety data on this approach as well as established infection control practices are needed prior to widespread implementation. 55…”

Application of aerosol therapy in respiratory diseases in children: A Saudi expert consensus

“…[ 209 ] In contrast, a recent study revealed that common canister protocol resulted in significant cost savings with similar rates of ventilator-associated pneumonia, mortality, as well as hospital length of stay, compared to single-patient pMDI. [ 210 ] Accordingly, each hospital should evaluate the risk–benefit ratio before following a common canister protocol. [ 25 ]…”

Use of a Metered-Dose Inhaler Compared With a Vibrating Mesh Nebulizer During Mechanical Ventilation: Does It Really Matter?

“…14 Although pMDI use remains common during mechanical ventilation, there is ongoing contention regarding the use of shared (common) canister protocol versus single canister therapy. Gowen et al 21 found that common canister protocol does yield cost savings but may result in more ventilator-associated events. A study by Ari et al 14 suggested that the use of a vibrating mesh nebulizer during mechanical ventilation was superior to the use of traditional jet nebulizer with a 2-4-fold greater drug delivery, but there may be significant variance among certain models of vibrating mesh nebulizers affecting the overall consistency of dosing.…”