nach oben

Erschienen in:

01.02.2016 | Original

Aerosol therapy in intensive and intermediate care units: prospective observation of 2808 critically ill patients

verfasst von: Stephan Ehrmann, Ferran Roche-Campo, Laetitia Bodet-Contentin, Keyvan Razazi, Jonathan Dugernier, Josep Trenado-Alvarez, Alexis Donzeau, François Vermeulen, David Thévoz, Metaxia Papanikolaou, Antoine Edelson, Héctor León Yoshido, Lise Piquilloud, Karim Lakhal, Carlos Lopes, Carlos Vicent, Arnaud Desachy, Gabriela Apiou-Sbirlea, Daniel Isabey, Laurent Brochard, Reva Research Network, AT@ICU Study Group

Erschienen in: Intensive Care Medicine | Ausgabe 2/2016

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Unlike in the outpatient setting, delivery of aerosols to critically ill patients may be considered complex, particularly in ventilated patients, and benefits remain to be proven. Many factors influence aerosol delivery and recommendations exist, but little is known about knowledge translation into clinical practice.

Methods

Two-week cross-sectional study to assess the prevalence of aerosol therapy in 81 intensive and intermediate care units in 22 countries. All aerosols delivered to patients breathing spontaneously, ventilated invasively or noninvasively (NIV) were recorded, and drugs, devices, ventilator settings, circuit set-up, humidification and side effects were noted.

Results

A total of 9714 aerosols were administered to 678 of the 2808 admitted patients (24 %, CI₉₅ 22–26 %), whereas only 271 patients (10 %) were taking inhaled medication before admission. There were large variations among centers, from 0 to 57 %. Among intubated patients 22 % (n = 262) received aerosols, and 50 % (n = 149) of patients undergoing NIV, predominantly (75 %) inbetween NIV sessions. Bronchodilators (n = 7960) and corticosteroids (n = 1233) were the most frequently delivered drugs (88 % overall), predominantly but not exclusively (49 %) administered to patients with chronic airway disease. An anti-infectious drug was aerosolized 509 times (5 % of all aerosols) for nosocomial infections. Jet-nebulizers were the most frequently used device (56 %), followed by metered dose inhalers (23 %). Only 106 (<1 %) mild side effects were observed, despite frequent suboptimal set-ups such as an external gas supply of jet nebulizers for intubated patients.

Conclusions

Aerosol therapy concerns every fourth critically ill patient and one-fifth of ventilated patients.

Nur mit Berechtigung zugänglich

Dolovich MB, Dhand R (2011) Aerosol drug delivery: developments in device design and clinical use. Lancet 377:1032–1045CrossRefPubMed

Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2014) Global strategy for the diagnosis, management and prevention of COPD. http://www.goldcopd.org/. Accessed 27 July 2015

Global Initiative for Asthma (GINA) (2014) Global strategy for asthma management and prevention. http://www.ginasthma.org/. Accessed 27 July 2015

Mogayzl PJ, Naureckas ET, Robinson KA, Mueller G, Hadjiliadis D, Hoag JB, Lubsch L, Hazle L, Sabadosa K, Marshall B, Committee Pulmonary Clinical Practice Guidelines (2013) Cystic fibrosis pulmonary guidelines. Chronic medications for maintenance of lung health. Am J Respir Crit Care Med 187:680–689CrossRef

O’Doherty MJ, Thomas SH (1997) Nebuliser therapy in the intensive care unit. Thorax 52:S56–S59PubMedCentralCrossRefPubMed

Ari A, Fink JB, Dhand R (2012) Inhalation therapy in patients receiving mechanical ventilation: an update. J Aerosol Med Pulm Drug Deliv 25:319–332CrossRefPubMed

Vecellio L, Guérin C, Grimbert D, De Monte M, Diot P (2005) In vitro study and semiempirical model for aerosol delivery control during mechanical ventilation. Intensive Care Med 31:871–876CrossRefPubMed

Diot P, Morra L, Smaldone GC (1995) Albuterol delivery in a model of mechanical ventilation. Comparison of metered-dose inhaler and nebulizer efficiency. Am J Respir Crit Care Med 152:1391–1394CrossRefPubMed

Miller DD, Amin MM, Palmer LB, Shah AR, Smaldone GC (2003) Aerosol delivery and modern mechanical ventilation: in vitro/in vivo evaluation. Am J Respir Crit Care Med 168:1205–1209CrossRefPubMed

10.

Mojoli F, Iotti GA, Imberti R, Braschi A (2013) The importance of protecting the mechanical ventilator during colistin methanesulfonate nebulization. Intensive Care Med 39:535–536CrossRefPubMed

11.

Laube BL, Janssens HM, de Jongh FHC, Devadason SG, Dhand R, Diot P, Everard ML, Horvath I, Navalesi P, Voshaar T, Chrystyn H (2011) What the pulmonary specialist should know about the new inhalation therapies. Eur Respir J 37:1308–1331CrossRefPubMed

12.

Mancebo J, Amaro P, Lorino H, Lemaire F, Harf A, Brochard L (1991) Effects of albuterol inhalation on the work of breathing during weaning from mechanical ventilation. Am Rev Respir Dis 144:95–100CrossRefPubMed

13.

Mouloudi E, Prinianakis G, Kondili E, Georgopoulos D (2001) Effect of inspiratory flow rate on beta2-agonist induced bronchodilation in mechanically ventilated COPD patients. Intensive Care Med 27:42–46CrossRefPubMed

14.

Lu Q, Yang J, Liu Z, Gutierrez C, Aymard G, Rouby JJ (2011) Nebulized ceftazidime and amikacin in ventilator-associated pneumonia caused by Pseudomonas aeruginosa. Am J Respir Crit Care Med 184:106–115CrossRefPubMed

15.

Lu Q, Luo R, Bodin L, Yang J, Zahr N, Aubry A, Golmard JL, Rouby JJ (2012) Efficacy of high-dose nebulized colistin in ventilator-associated pneumonia caused by multidrug-resistant Pseudomonas aerugiosa and Acinetobacter baumannii. Anesthesiology 117:1335–1347CrossRefPubMed

16.

Palmer LB, Smaldone GC, Chen JJ, Baram D, Duan T, Monteforte M, Varela M, Tempone AK, O’Riordan T, Daroowalla F, Richman P (2008) Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit. Crit Care Med 36:2008–2013CrossRefPubMed

17.

Palmer LB, Smaldone GC (2014) Reduction of bacterial resistance with inhaled antibiotics in the intensive care unit. Am J Respir Crit Care Med 189:1225–1233CrossRefPubMed

18.

Esteban A, Ferguson ND, Meade MO, Frutos-Vivar F, Apezteguia C, Brochard L, Raymondos K, Nin N, Hurtado J, Tomicic V, Gonzalez M, Elizalde J, Nightingale P, Abroug F, Pelosi P, Arabi Y, Moreno R, Jibaja M, D’Empaire G, Sandi F, Matamis D, Montanez AM, Anzueto A, VENTILA Group (2008) Evolution of mechanical ventilation in response to clinical research. Am J Respir Crit Car Med 177:170–177CrossRef

19.

Esteban A, Frutos-Vivar F, Muriel A, Ferguson ND, Penuelas O, Abraira V, Raymondos K, Rios F, Nin N, Apezteguia C, Violi DA, Thille AW, Brochard L, Gonzalez M, Villagomez AJ, Hurtado J, Davies AR, Du B, Maggiore SM, Belosi P, Soto L, Tomicic V, D’Empaire G, Matamis D, Abroug F, Moreno RP, Soares MA, Arabi Y, Sandi F, Jibaja M, Amin P, Koh Y, Kuiper MA, Bülow HH, Zeggwagh AA, Anzueto A (2013) Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med 188:220–230CrossRefPubMed

20.

Ehrmann S, Roche-Campo F, Sferrazza Papa GF, Isabey D, Brochard L, Apiou-Sbirlea G, Reva Research Network (2013) Aerosol therapy during mechanical ventilation: an international survey. Intensive Care Med 39:1048–1056CrossRefPubMed

21.

Grivans C, Lindgren S, Aneman A, Stengwist O, Lundin S (2009) A Scandinavian survey of drug administration through inhalation, suctioning and recruitment maneuvers in mechanically ventilated patients. Acta Anaesthesiol Scand 53:710–716CrossRefPubMed

22.

Le Gall JR, Lemeshow S, Saulnier F (1993) A New Simplified Acute Physiology Score (SAPS II) Based on a European/North American Multicenter Study. JAMA 270:2957–2963CrossRefPubMed

23.

Fauroux B, Jtti E, Pigeot J, Isabey D, Meignan M, Ferry G, Lofaso F, Willemot JM, Clément A, Harf A (2000) Optimization of aerosol deposition by pressure support in children with cystic fibrosis: an experimental and clinical study. Am J Respir Crit Care Med 162:2265–2271CrossRefPubMed

24.

Nava S, Karakurt S, Rampulla C, Braschi A, Fanfulla F (2001) Salbutamol delivery during non-invasive mechanical ventilation in patients with chronic obstructive pulmonary disease: a randomized, controlled study. Intensive Care Med 27:1627–1635CrossRefPubMed

25.

Galindo-Filho VC, Brandao DC, Ferreira RC, Menezes MJ, Ameida-Filho P, Parreira VF, Silva TN, Rodrigues-Machado MG, Dean E, Dornelas de Andrade A (2013) Non invasive ventilation coupled with nebulization during asthma crises: a randomized controlled trial. Respir Care 58:241–249CrossRefPubMed

26.

Hess DR (2015) Aerosol therapy during noninvasive ventilation or high-flow nasal cannula. Respir Care 60:880–893CrossRefPubMed

27.

Ehrmann S, Lyazidi A, Louis B, Isabey D, Le Pennec D, Brochard L, Apiou-Sbirlea G (2014) Ventilator-integrated jet nebulization systems: tidal volume control and efficiency of synchronization. Respir Care 59:1508–1516CrossRefPubMed

28.

Kiatboonsri S, Kiatboonsri C, Theerawit P (2010) Fatal respiratory events caused by zanamivir nebulization. Clin Infect Dis 50:620CrossRefPubMed

29.

Davies JB, Bromilow J (2011) Bacterial filter obstruction with the use of ultrasonic nebulisation. Anaesthesia 66:394–395CrossRefPubMed

30.

Tonnelier A, Lellouche F, Bouchard PA, L’Her E (2013) Impact of humidification and nebulization during expiratory limb protection: an experimental bench study. Respir Care 58:1315–1322CrossRefPubMed

31.

Rouby JJ, Bouhemad B, Monsel A, Brisson H, Arbelot C, Lu Q, the Nebulized Antibiotics Study Group (2012) Aerosolized antibiotics for ventilator-associated pneumonia: lessons from experimental studies. Anesthesiology 117:1364–1380CrossRefPubMed

32.

Elman M, Goldstein I, Marquett CH, Wallet F, Lenaour G, Rouby JJ, Experimental ICU Study Group (2002) Influence of lung aeration on pulmonary concentrations of nebulized and intravenous amikacin in ventilated piglets with severe bronchopneumonia. Anesthesiology 97:199–206CrossRefPubMed

33.

Palmer LB, Smaldone GC, Simon SR, O’Riordan TG, Cuccia A (1998) Aerosolized antibiotics in mechanically ventilated patients: delivery and response. Crit Care Med 26:31–39CrossRefPubMed

34.

Valachis A, Samonis G, Kofteridis DP (2015) The role of aerosolized colistin in the treatment of ventilator-associated pneumonia: a systematic review and metaanalysis. Crit Care Med 43:527–533CrossRefPubMed

35.

Nava S, Compagnoni ML (2000) Controlled short-term trial of fluticasone propionate in ventilator-dependent patients with COPD. Chest 118:990–999CrossRefPubMed

36.

Jaillette E, Nseir S (2011) Relationship between inhaled β₂-agonists and ventilator-associated pneumonia: a cohort study. Crit Care Med 39:725–730CrossRefPubMed

Titel: Aerosol therapy in intensive and intermediate care units: prospective observation of 2808 critically ill patients
verfasst von: Stephan Ehrmann
Ferran Roche-Campo
Laetitia Bodet-Contentin
Keyvan Razazi
Jonathan Dugernier
Josep Trenado-Alvarez
Alexis Donzeau
François Vermeulen
David Thévoz
Metaxia Papanikolaou
Antoine Edelson
Héctor León Yoshido
Lise Piquilloud
Karim Lakhal
Carlos Lopes
Carlos Vicent
Arnaud Desachy
Gabriela Apiou-Sbirlea
Daniel Isabey
Laurent Brochard
Reva Research Network
AT@ICU Study Group
Publikationsdatum: 01.02.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 2/2016
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-015-4114-5

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

Aerosol therapy in intensive and intermediate care units: prospective observation of 2808 critically ill patients