How should aerosols be delivered during invasive mechanical ventilation?

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

The delivery of aerosols to mechanically ventilated patients presents unique challenges and differs from inhaled drug delivery in spontaneously breathing patients in several respects. Successful aerosol delivery during invasive mechanical ventilation requires careful consideration of a host of factors that influence the amount of drug inhaled by the patient. Pressurized metered-dose inhalers and nebulizers (jet, ultrasonic, and vibrating mesh) are the most commonly used aerosol delivery devices in these patients, although other delivery devices, such as dry powder inhalers, soft mist inhalers, and intratracheal nebulizing catheters, could also be adapted for in-line use. Bronchodilators, inhaled corticosteroids, antibiotics, pulmonary surfactant, mucolytics, biologicals, genes, prostanoids, and other agents are administered by inhalation during mechanical ventilation for a variety of indications. The goals of inhalation therapy during mechanical ventilation could be best achieved by (1) assuring drug delivery; (2) optimizing drug deposition in the lung; (3) providing consistent dosing; (4) avoiding inappropriate therapies; (5) achieving reproducible dosing; (6) employing clinically feasible methods; (7) enhancing the safety of inhaled drugs; and (8) controlling costs of aerosol therapy. The techniques of administration of aerosols with various delivery devices during mechanical ventilation are well known, but there continues to be significant variation in clinical practice and guidelines are needed to provide best practices for a wide range of clinical settings encountered in mechanically ventilated patients.

Original languageEnglish (US)
Pages (from-to)1343-1367
Number of pages25
JournalRespiratory care
Volume62
Issue number10
DOIs
StatePublished - Oct 1 2017

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Aerosols
Artificial Respiration
Pharmaceutical Preparations
Nebulizers and Vaporizers
Practice Guidelines
Equipment and Supplies
Dry Powder Inhalers
Expectorants
Pulmonary Surfactants
Metered Dose Inhalers
Respiratory Therapy
Bronchodilator Agents
Ultrasonics
Inhalation
Prostaglandins
Adrenal Cortex Hormones
Respiration
Catheters
Anti-Bacterial Agents
Safety

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

How should aerosols be delivered during invasive mechanical ventilation? / Dhand, Rajiv.

In: Respiratory care, Vol. 62, No. 10, 01.10.2017, p. 1343-1367.

Research output: Contribution to journalArticle

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