Skip to main content

Lights and Shadows on Aerosol Therapy in Mechanically Ventilated Patients

  • Chapter
  • First Online:
Practical Issues in Anesthesia and Intensive Care 2013

Abstract

The term aerosol refers to the fine dispersion in a gas, suitable to be breathed in, (dispersing phase) of liquid or solid particles (dispersed phase). It can be considered as the means of transport of a drug to the airways in the form of small liquid or solid particles (with a diameter from 2 to 100 μ).

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
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

References

  1. Dolovich MB, Ahrens RC, Hess DR, Anderson P et al (2005) Device selection and outcomes of aerosol therapy: evidence-based guidelines American college of chest physicians/American college of asthma allergy, and immunology. Chest 127:335–371

    Article  PubMed  Google Scholar 

  2. Manocha S, Walley KR (2005) Respiratory therapy. In: Fink MP, Abraham E (eds) Terapia intensiva, Elsevier, Masson, pp 526–531

    Google Scholar 

  3. Newman SP (1985) Aerosol deposition considerations in inhalation therapy. Chest 88:152S–160S

    Article  PubMed  CAS  Google Scholar 

  4. Ruickbie S, Hall A, Ball J (2011) Therapeutic aerosols in mechanically ventilated patients. In: Vincent J-L (ed) Annual update in intensive care and emergency medicine, Springer, Berlin

    Google Scholar 

  5. 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. Pharm Res 19:239–245

    Article  PubMed  CAS  Google Scholar 

  6. Reay CA, Bousfield DR, Colchin ES, Menes JA, Sims AJ (2009) Buyers’ guide: Nebulizers. In: NHS purchasing and supply agency centre for evidence-based purchasing, London

    Google Scholar 

  7. Rau JL Jr (2002) Respiratory care pharmacology, 6th edn. Mosby, St. Louis

    Google Scholar 

  8. Newhouse MT (1982) Principles of aerosol therapy. Chest 82:39S–41S

    Article  PubMed  CAS  Google Scholar 

  9. Palmer LB, Smaldone GC, Chen JJ, Baram D, Duan T et al (2008) Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit. Crit Care Med 36(7):2008–2013

    Article  PubMed  CAS  Google Scholar 

  10. 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 

  11. Hess DR, Myers TR, Rau JL (2005) A guide to aerosol delivery devices for respiratory therapists. American Association for Respiratory Care, Dallas

    Google Scholar 

  12. Idris AH, McDermott MF, Raucci JC et al (1993) Emergency department treatment of severe asthma: metered-dose inhaler plus holding chamber is equivalent in effectiveness to nebulizer. Chest 103:665–672

    Article  PubMed  CAS  Google Scholar 

  13. AARC (1992) Clinical Practice guidelness. Selection of device, administration of Bronchodilatator and evaluation of response to therapy in mechanically ventilated patients. Respir Care 44:105–113

    Google Scholar 

  14. Georgopoulos D, Mouloudi E, Kondili E, Klimathianaki M (2000) Bronchodilator delivery with metered-dose inhaler during mechanical ventilation. Crit Care 4:227–235

    Article  PubMed  CAS  Google Scholar 

  15. Lin HL, Fink JB, Zhou Y, Cheng YS (2009) Influence of moisture accumulation in inline spacer on delivery of aerosol using metered-dose inhaler during mechanical ventilation. Respir Care 54:1336–1345

    PubMed  Google Scholar 

  16. Dhand R (2004) Basic techniques for aerosol delivery during mechanical ventilation. Respir Care 49:611–620

    PubMed  Google Scholar 

  17. 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 2010:CD004711

    Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  19. 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 

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

    Google Scholar 

  21. Dhand R, Guntur VP (2008) How best to deliver aerosol medications to mechanically ventilated patients. Clin Chest Med 29:277–289

    Article  PubMed  Google Scholar 

  22. Ari A, Atalay OT, Harwood R et al (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 55:845–855

    PubMed  Google Scholar 

  23. Hess D (2002) Aerosol delivery during mechanical ventilation. Minerva Anestesiol 68:321–328

    PubMed  CAS  Google Scholar 

  24. Dhand R (2008) Aerosol delivery during mechanical ventilation: from basic techniques to new devices. J Aerosol Med Pulm Drug Deliv 21:45

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  Google Scholar 

  27. Manthous CA, Chatila W, Schmidt GA, Hall JR (1995) Treatment of bronchospasm by metered-dose inhaler albuterol in mechanically ventilated patients. Chest 107:210–213

    Article  PubMed  CAS  Google Scholar 

  28. Maclntyre NR, Silver RM, Miller CW, Schuler F, Coleman E (1985) Aerosol delivery in intubated, mechanically ventilated patients. Crit Care Med 13:81–84

    Article  Google Scholar 

  29. National Heart, Lung and Blood Institute (NHLBI) (2008) Drug study of Albuterol to treat Acute Lung Injury (ALTA). http://clinaltrials.gov/ct2/show/NCT00434993 Accessed 11 Oct 2010

  30. The Beta-2 Agonist Lung Injury Trial 2 UK Clinical Research Network (2010) Balti-2 (Beta Agonist Lung injury Trial-2). http://www2.warwick.ac.uk/fac/med7research/ctu/trials/ecr/balti2 Accessed 11 oct 2010

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

    Article  PubMed  CAS  Google Scholar 

  32. Creagh-Brown BC, Ball J (2008) An under-recognized complication of treatment of acute severe asthma. Am J Emerg Med 26:514,e 1–3

    Google Scholar 

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

    Article  Google Scholar 

  34. Truwit JD (1991) Toxic effects of bronchodilatators. Crit Care Clin 7:1337–1342

    Google Scholar 

  35. 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 

  36. British thoracic Society and the Scottish Intercollegiate Guidelines Network (2009) British guidelines on the management of asthma. www.britthoracic.org.uk/Portals/Clinical/Information/Asthma/guidelines/20 June2009

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

    Article  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  40. 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 

  41. Kay AB (1991) Asthma and inflammation. J Allergy Clin Immunol 87:893–945

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  44. Nash EF, Stephenson A, Ratjen F, Tullis E (2009) Nebulized and oral thiol derivatives for pulmonary disease in cystic fibrosis. Cochrane Database Syst Rev 168:CD007168

    Google Scholar 

  45. Wark P, McDonald VM (2009) Nebulised hypertonic saline for cystic fibrosis. Cochrane Database Syst Rev 168:CD001506

    Google Scholar 

  46. Jacques A, Daviskas E, Turton JA et al (2008) Inhaled mannitol improves lung function in cystic fibrosis. Chest 133:1338–1396

    Google Scholar 

  47. Willis PJ, Greenstone M (2006) Inhaled hyperosmolar agents for bronchiectasis. Cochrane Database Syst Rev 168:CD002996

    Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  50. 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 

  51. Craven DE, Chroneou A, Zias N, Hjalmarson KI (2009) Ventilator associated tracheobronchitis. Chest 135:521–528

    Article  PubMed  Google Scholar 

  52. Smaldone GC (2004) Aerosolized antibiotics in mechanically ventilated patients. Respir Care 49(6):635–639

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  55. Palmer L, Smaldone G, Chen JJ et al (2008) Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit. Crit Care Med 36:2008–2013

    Article  PubMed  CAS  Google Scholar 

  56. Luyt C E et al (2009) Pharmacokinetics and lung delivery of PDDS-aerosolized amikacin (NKTR-061) in intubated and mechanically ventilated patients with nosocomial pneumonia. Critical Care 13(6):R200

    Google Scholar 

  57. Afshari A, Brock J, Moller AM, Wetterslev J (2010) Aeosolized prostacyclin for acute lung injury (ALI) and acute respiratory distress syndrome (ARDSS). Cochrane Database Syst Rev 168:CD007733

    Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  59. Harris KW, O’Riordan TG, and Smaldone GC (2007) Aerosolized iloprost customized for the critically ill. Respir Care 52(11):1507–1509

    Google Scholar 

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

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Davide Chiumello .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Italia

About this chapter

Cite this chapter

Chiumello, D., Coppola, S. (2014). Lights and Shadows on Aerosol Therapy in Mechanically Ventilated Patients. In: Allaria, B. (eds) Practical Issues in Anesthesia and Intensive Care 2013. Springer, Milano. https://doi.org/10.1007/978-88-470-5529-2_5

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-5529-2_5

  • Published:

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-5528-5

  • Online ISBN: 978-88-470-5529-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics