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Drugs

, Volume 77, Issue 13, pp 1399–1412 | Cite as

Inhaled Antimicrobials for Ventilator-Associated Pneumonia: Practical Aspects

  • Garyphallia Poulakou
  • Dimitrios K. Matthaiou
  • David P. Nicolau
  • Georgios Siakallis
  • George Dimopoulos
Therapy in Practice

Abstract

Positive experience with inhaled antibiotics in pulmonary infections of patients with cystic fibrosis has paved the way for their utilization in mechanically ventilated, critically ill patients with lower respiratory tract infections. A successful antibiotic delivery depends upon the size of the generated particle and the elimination of drug impaction in the large airways and the ventilator circuit. Generated droplet size is mainly affected by the type of the nebulizer employed. Currently, jet, ultrasonic, and vibrating mesh nebulizers are marketed; the latter can deliver optimal antibiotic particle size. Promising novel drug-device combinations are able to release drug concentrations of 25- to 300-fold the minimum inhibitory concentration of the targeted pathogens into the pulmonary alveoli. The most important practical steps of nebulization include pre-assessment and preparation of the patient (suctioning, sedation, possible bronchodilation, adjustment of necessary ventilator settings); adherence to the procedure (drug preparation, avoidance of unnecessary tubing connections, interruption of heated humidification, removal of heat-moisture exchanger); inspection of the procedure (check for residual in drug chamber, change of expiratory filter, return sedation, and ventilator settings to previous status); and surveillance of the patient for adverse events (close monitoring of the patient and particularly of peak airway pressure and bronchoconstriction). Practical aspects of nebulization are very important to ensure optimal drug delivery and safe procedure for the patient. Therefore, the development of an operational checklist is a priority for every department adopting this modality.

Notes

Acknowledgements

We would like to thank Dr I.T. Virlos for the linguistic revision of the manuscript.

Compliance with ethical standards

Funding

No funding was received for the preparation of this article.

Conflict of interest

GP, DKM, DPN, GS, and GD have no conflicts of interest directly relevant to the content of this article.

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© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Fourth Department of Internal Medicine and Infectious Diseases UnitAthens National and Kapodistrian University, Medical School, Attikon University General Hospital of AthensAthensGreece
  2. 2.Department of Critical Care, University Hospital Attikon, Faculty of MedicineNational and Kapodistrian University of AthensAthensGreece
  3. 3.Center for Anti-Infective Research and Development, Hartford HospitalHartfordUSA

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