Skip to main content
SpringerLink
Log in

Therapeutic Aerosols in Mechanically Ventilated Patients

  • Chapter
Annual Update in Intensive Care and Emergency Medicine 2011

Part of the book series: Annual Update in Intensive Care and Emergency Medicine 2011 ((AUICEM,volume 1))

Abstract

  • An aerosol is a suspension of solid or liquid particles in a gas.

  • A nebulizer is a device that can convert a liquid into aerosol droplets suitable for patient inhalation.

Aerosols have been used medicinally for thousands of years [1]. The inherent appeal of therapeutic aerosols is two fold: First, the delivery of pulmonary pharmaceuticals direct to the tracheo-bronchial and/or alveolar epithelium, and second, the rapid delivery of drugs to the systemic circulation. The latter, exploits the easily accessible, large absorptive surface area and minimal diffusion distance to the circulation that the respiratory tract provides, together with avoidance of first pass entero-hepatic metabolism.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Rubin BK (2010) Air and soul: the science and application of aerosol therapy. Respir Care 55: 911–921

    PubMed  Google Scholar 

  2. Crowder TM, Rosati JA, Schroeter JD, Hickey AJ, Martonen TB (2002) Fundamental effects of particle morphology on lung delivery: Predictions of Stokes’ law and the particular relevance to dry powder inhaler formulation and development. Pharmaceutical Res 19: 239–245

    Article  CAS  Google Scholar 

  3. Reay CA, Bousfield DR, Colechin ES, Menes JA, Sims AJ (2009) Buyers’ guide: Nebulizers. NHS Purchasing and Supply Agency Centre for Evidence-based Purchasing, London

    Google Scholar 

  4. Dhand R (2005) Inhalation therapy with metered-dose inhalers and dry powder inhalers in mechanically ventilated patients. Respir Care 50: 1331–1334

    PubMed  Google Scholar 

  5. Ali M, Mazumder MK, Martonen TB (2009) Measurements of electrodynamic effects on the deposition of MDI and DPI aerosols in a replica cast of human oral-pharyngeal-laryngeal airways. J Aerosol Med Pulm Drug Deliv 22: 35–44

    Article  PubMed  Google Scholar 

  6. Ari A, Atalay OT, Harwood R, Sheard MM, Aljamhan EA, Fink JB (2010) Influence of nebulizer type, position, and bias flow on aerosol drug delivery in simulated pediatric and adult lung models during mechanical ventilation. Respir Care 55: 845–851

    PubMed  Google Scholar 

  7. Kelly M, Gillies D, Todd David A, Lockwood C (2010) Heated humidification versus heat and moisture exchangers for ventilated adults and children. Cochrane Database Syst Rev CD004711

    Google Scholar 

  8. Demers RR, (2001) Bacterial/viral filtration. Chest 120: 1377–1389

    Article  PubMed  CAS  Google Scholar 

  9. Ari A, Areabi H, Fink JB (2010) Evaluation of aerosol generator devices at 3 locations in humidified and non-humidified circuits during adult mechanical ventilation. Respir Care 55: 837–844

    PubMed  Google Scholar 

  10. Arieta AG (2010) Bioequivalence assessment of inhalation products: Interchangeability study design and statistical methods. Pulm Pharmacol Ther 23: 156–158

    Article  PubMed  CAS  Google Scholar 

  11. Mutlu GM, Factor P (2008) Alveolar epithelial 2-adrenergic receptors. Am J Respir Cell Mol Biol 38: 127–134

    Article  PubMed  CAS  Google Scholar 

  12. Restrepo RD (2007) Inhaled adrenergics and anticholinergics in obstructive lung disease: do they enhance mucociliary clearance? Respir Care 52: 1159–1173

    PubMed  Google Scholar 

  13. National Heart, Lung, and Blood Institute (NHLBI) (2008) Drug Study of Albuterol to Treat Acute Lung Injury (ALTA). Available at: http://clinicaltrials.gov/ct2/show/NCT00434993 Accessed 11 October 2010

    Google Scholar 

  14. The Beta-2 Agonist Lung Injury Trial 2 UK Clinical Research Network (2010) Balti-2 (Beta Agonist Lung injury TrIal — 2). Available at: http://www2.warwick.ac.uk/fac/med/research/ctu/trials/ecr/balti2 Accessed 11 October 2010

    Google Scholar 

  15. Ameredes BT, Calhoun WJ (2006) (R)-albuterol for asthma: pro [a.k.a. (S)-albuterol for asthma: con]. Am J Respir Crit Care Med 174: 965–969

    Article  PubMed  CAS  Google Scholar 

  16. Creagh-Brown BC, Ball J (2008) An under-recognized complication of treatment of acute severe asthma. Am J Emerg Med 26: 514, el–3

    PubMed  Google Scholar 

  17. Adam JS, Charles E, Douglas MC, et al (2008) Bronchodilator therapy in acute decompensated heart failure patients without a history of chronic obstructive pulmonary disease. Ann Emerg Med 51: 25–34

    Article  Google Scholar 

  18. Camargo CA, Jr., Rachelefsky G, Schatz M (2009) Managing asthma exacerbations in the emergency department: Summary of the National Asthma Education and Prevention Program Expert Panel Report 3 Guidelines for the Management of Asthma Exacerbations. Proc Am Thorac Soc 6: 357–366

    Article  PubMed  Google Scholar 

  19. British Thoracic Society and the Scottish Intercollegiate Guidelines Network (2009) British Guideline on the Management of Asthma. Available at: http://www.brit-thoracic.org.Uk/Portals/0/Clinical%20Information/Asthma/Guidelines/signlOl %20revised%20June%2009.pdf Accessed 11 October 2010

    Google Scholar 

  20. Mohammed S, Goodacre S (2007) Intravenous and nebulised magnesium sulphate for acute asthma: systematic review and meta-analysis. Emerg Med J 24: 823–830

    Article  PubMed  CAS  Google Scholar 

  21. Wiebe K, Rowe BH (2007) Nebulized racemic epinephrine used in the treatment of severe asthmatic exacerbation: a case report and literature review. CJEM 9: 304–308

    PubMed  Google Scholar 

  22. Chong CF, Chen CC, Ma HP, Wu YC, Chen YC, Wang TL (2005) Comparison of lidocaine and bronchodilator inhalation treatments for cough suppression in patients with chronic obstructive pulmonary disease. Emerg Med J 22: 429–432

    Article  PubMed  Google Scholar 

  23. Hunt LW, Frigas E, Butterfield JH, et al (2004) Treatment of asthma with nebulized lidocaine: A randomized, placebo-controlled study. J Allergy Clin Immunol 113: 853–859

    Article  PubMed  CAS  Google Scholar 

  24. Mannam P, Siegel MD (2010) Analytic review: Management of life-threatening asthma in adults. J Intensive Care Med 25: 3–15

    Article  PubMed  Google Scholar 

  25. Rogers DF (2007) Mucoactive agents for airway mucus hypersecretory diseases. Respir Care 52: 1176–1193

    PubMed  Google Scholar 

  26. Voynow JA, Rubin BK (2009) Mucins, mucus, and sputum. Chest 135: 505–512

    Article  PubMed  CAS  Google Scholar 

  27. Nash EF, Stephenson A, Ratjen F, Tullis E (2009) Nebulized and oral thiol derivatives for pulmonary disease in cystic fibrosis. Cochrane Database Syst Rev: CD007168

    Google Scholar 

  28. Wark P, McDonald VM (2009) Nebulised hypertonic saline for cystic fibrosis. Cochrane Database Syst Rev: CD001506

    Google Scholar 

  29. Jaques A, Daviskas E, Turton JA, et al (2008) Inhaled mannitol improves lung function in cystic fibrosis. Chest 133: 1388–1396

    Article  PubMed  CAS  Google Scholar 

  30. Wills PJ, Greenstone M (2006) Inhaled hyperosmolar agents for bronchiectasis. Cochrane Database Syst Rev: CD002996

    Google Scholar 

  31. Prodhan P, Greenberg B, Bhutta AT, et al (2009) Recombinant human deoxyribonuclease improves atelectasis in mechanically ventilated children with cardiac disease. Congenit Heart Dis 4: 166–173

    Article  PubMed  Google Scholar 

  32. Riethmueller J, Kumpf M, Borth-Bruhns T, et al (2009) Clinical and in vitro effect of dornase alfa in mechanically ventilated pediatric non-cystic fibrosis patients with atelectases. Cell Physiol Biochem 23: 205–210

    Article  PubMed  CAS  Google Scholar 

  33. Afshari A, Brøk J, Moller Ann M, Wetterslev J (2010) Aerosolized prostacyclin for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Cochrane Database Syst Rev CD007733

    Google Scholar 

  34. Ivy DD (2010) Prostacyclin in the intensive care setting. Pediatr Crit Care Med 11: S41–45

    Article  PubMed  Google Scholar 

  35. Gomberg-Maitland M, Olschewski H (2008) Prostacyclin therapies for the treatment of pulmonary arterial hypertension. Eur Respir J 31: 891–901

    Article  PubMed  CAS  Google Scholar 

  36. Ichinose F, Erana-Garcia J, Hromi J, et al (2001) Nebulized sildenafil is a selective pulmonary vasodilator in lambs with acute pulmonary hypertension. Crit Care Med 29: 1000–1005

    Article  PubMed  CAS  Google Scholar 

  37. O’Callaghan DS, Savale L, Jaïs X, et al (2010) Evidence for the use of combination targeted therapeutic approaches for the management of pulmonary arterial hypertension. Respir Med 104: S74–S80

    Article  PubMed  Google Scholar 

  38. Torres A, Ewig S, Lode H, Carlet J (2009) Defining, treating and preventing hospital acquired pneumonia: European perspective. Intensive Care Med 35: 9–29

    Article  PubMed  Google Scholar 

  39. Craven DE, Chroneou A, Zias N, Hjalmarson KI (2009) Ventilator-associated tracheobron-chitis. Chest 135: 521–528

    Article  PubMed  Google Scholar 

  40. Dhand R (2007) The role of aerosolized antimicrobials in the treatment of ventilator-associated pneumonia. Respir Care 52: 866–884

    PubMed  Google Scholar 

  41. Palmer LB (2009) Aerosolized antibiotics in critically ill ventilated patients. Curr Opin Crit Care 15: 413–418

    Article  PubMed  Google Scholar 

  42. Toon MH, Maybauer MO, Greenwood JE, Maybauer DM, Fraser JF (2010) Management of acute smoke inhalation injury. Crit Care Resusc 12: 53–61

    PubMed  Google Scholar 

  43. Asian S, Kandis H, Akgun M, Cakir Z, Inandi T, Gorguner M (2006) The effect of nebulized NaHC03 treatment on “RADS” due to chlorine gas inhalation. Inhal Toxicol 18: 895–900

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. General Intensive Care Unit, St George’s Hospital, 118a Durham Road, London, SW20 0DG, UK

    S. Ruickbie

  2. General Intensive Care Unit, St George’s Hospital, 72A East Dulwich Grove, London, SE22 8PS, UK

    A. Hall

  3. General Intensive Care Unit 1st Floor, St James’ Wing, St George’s Hospital, London, SW17 0QT, UK

    J. Ball

Authors
  1. S. Ruickbie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Hall
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Ball
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium

    Jean-Louis Vincent (Head) (Head)

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media LLC

About this chapter

Cite this chapter

Ruickbie, S., Hall, A., Ball, J. (2011). Therapeutic Aerosols in Mechanically Ventilated Patients. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2011. Annual Update in Intensive Care and Emergency Medicine 2011, vol 1. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-18081-1_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-18081-1_17

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-18080-4

  • Online ISBN: 978-3-642-18081-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation