Therapeutic aerosol delivery during mechanical ventilation

OBJECTIVE: To provide an overview of aerosol drug delivery during mechanical ventilation in the pediatric and adult populations. DATA SOURCES: Published articles and abstracts identified in a MEDLINE search (1984-July 1994) were reviewed. STUDY SELECTION: All articles and abstracts found, including review articles, in vivo and in vitro studies, case reports, and case series pertaining to issues involving aerosol delivery during mechanical ventilation, were reviewed. No predetermined selection criteria were used to exclude studies. DATA EXTRACTION: Percent delivery of the starting dose to either the patients or the various in vitro lung models, as well as each variable possibly affecting delivery for each study, were tabulated for each study reviewed. DATA SYNTHESIS: The delivery of therapeutic aerosols to endotracheally intubated and mechanically ventilated patients presents a unique challenge for healthcare providers. Delivery can be affected by the diameter of the endotracheal tube and ventilator circuitry, type of ventilator, ventilator modes, type of delivery device, and how the delivery device is operated and introduced into the ventilator circuitry. The drug being aerosolized may behave differently from one delivery system to another. The proper operation of each device requires attention to positioning in the ventilator circuit as well as the mode of ventilation. CONCLUSIONS: No apparent advantage exists for metered-dose inhalers with a large-volume adapter over jet nebulizers, as each method of delivery is capable of similar efficiency (5-15%). Sufficient attention to detail, including the use of an efficient nebulizer and/or adapter and proper placement and operating method, is required to provide optimal delivery. For bronchodilator administration, careful monitoring of outcomes will provide the most optimal dosing schedule.

This article has been cited by other articles:

				H W. Kelly, K. A Keim, and B. C McWilliams Comparison of Two Methods of Delivering Continuously Nebulized Albuterol Ann. Pharmacother., January 1, 2003; 37(1): 23 - 26. [Abstract] [Full Text] [PDF]

				J. Sherman Care of the Child with a Chronic Tracheostomy . THIS OFFICIAL STATEMENT OF THE AMERICAN THORACIC SOCIETY WAS ADOPTED BY THE ATS BOARD OF DIRECTORS, JULY 1999 Am. J. Respir. Crit. Care Med., January 1, 2000; 161(1): 297 - 308. [Full Text]

				M. A. Jantz and N. A. Collop Bronchodilator Aerosol Delivery in Mechanical Ventilation: Jantz MA, Collop NA Bronchodilator Aerosol Delivery in Mechanical Ventilation Intensive Care Med 1999,14 166-183 J Intensive Care Med, July 1, 1999; 14(4): 166 - 183. [PDF]

				C. GUERIN, A. CHEVRE, P. DESSIRIER, T. PONCET, M.-H. BECQUEMIN, P. F. DEQUIN, C. LE GUELLEC, D. JACQUES, and G. FOURNIER Inhaled Fenoterol-Ipratropium Bromide in Mechanically Ventilated Patients with Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., April 1, 1999; 159(4): 1036 - 1042. [Abstract] [Full Text] [PDF]