Aerosol therapy in patients receiving noninvasive positive pressure ventilation

Research output: Contribution to journalReview article

53 Citations (Scopus)

Abstract

In selected patients, noninvasive positive pressure ventilation (NIPPV) with a facemask is now commonly employed as the first choice for providing mechanical ventilation in the intensive care unit (ICU). Aerosol therapy for treatment of acute or acute-on-chronic respiratory failure in this setting may be delivered by pressurized metered-dose inhaler (pMDI) with a chamber spacer and facemask or nebulizer and facemask. This article reviews the host of factors influencing aerosol delivery with these devices during NIPPV. These factors include (1) the type of ventilator, (2) mode of ventilation, (3) circuit conditions, (4) type of interface, (5) type of aerosol generator, (6) drug-related factors, (7) breathing parameters, and (8) patient-related factors. Despite the impediments to efficient aerosol delivery because of continuous gas flow, high inspiratory flow rates, air leaks, circuit humidity, and patient-ventilator asynchrony, significant therapeutic effects are achieved after inhaled bronchodilator administration to patients with asthma and chronic obstructive pulmonary disease. Similarly to invasive mechanical ventilation, careful attention to the technique of drug administration is required to optimize therapeutic effects of inhaled therapies during NIPPV. Assessment of the patient's ability to tolerate a facemask, the level of respiratory distress, hemodynamic status, and synchronization of aerosol generation with inspiratory airflow are important factors contributing to the success of aerosol delivery during NIPPV. Further research into novel delivery methods, such as the use of NIPPV with nasal cannulae, could enhance the efficiency, ease of use, and reproducibility of inhalation therapy during noninvasive ventilation.

Original languageEnglish (US)
Pages (from-to)63-78
Number of pages16
JournalJournal of Aerosol Medicine and Pulmonary Drug Delivery
Volume25
Issue number2
DOIs
StatePublished - Apr 1 2012
Externally publishedYes

Fingerprint

Positive-Pressure Respiration
Aerosols
Therapeutic Uses
Mechanical Ventilators
Artificial Respiration
Therapeutics
Metered Dose Inhalers
Respiratory Therapy
Noninvasive Ventilation
Nebulizers and Vaporizers
Bronchodilator Agents
Humidity
Respiratory Insufficiency
Pharmaceutical Preparations
Chronic Obstructive Pulmonary Disease
Intensive Care Units
Ventilation
Respiration
Asthma
Gases

All Science Journal Classification (ASJC) codes

  • Medicine(all)
  • Pulmonary and Respiratory Medicine
  • Pharmaceutical Science
  • Pharmacology (medical)

Cite this

Aerosol therapy in patients receiving noninvasive positive pressure ventilation. / Dhand, Rajiv.

In: Journal of Aerosol Medicine and Pulmonary Drug Delivery, Vol. 25, No. 2, 01.04.2012, p. 63-78.

Research output: Contribution to journalReview article

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