Aerosol delivery during Mechanical Ventilation In this

Aerosol delivery during Mechanical Ventilation

In this conference…

I learn some things and I want to share with you today

Introduction

Delivery methods

Purpose of this presentation

Factors influencing aerosol delivery in mechanical ventilation

Factors influencing aerosol delivery

Ventilator-related

Circuit-related Aerosol delivery in intubated, mechanically ventilated patients CCM 1985; 13(2): 81 -84

Circuit-related

Circuit-related

Circuit-related Inhalaed bronchodilator therapy in mechanically ventilated patients Am J Respir Crit Care Med 1997; 156: 3 -10

Circuit-related Fink JB, Dhand R, Grychowski J, Fahey PJ, Tobin MJ. Reconciling in vitro and in vivo measurements of aerosol delivery from a metered- dose inhaler during mechanical ventilation and defining efficiency enhancing factors. Am J Respir Crit Care Med 1999; 159(1): 63– 68.

Circuit-related

Device-related: MDI

Device-related: MDI

Device-related: MDI

Device-related: MDI

Device-related: MDI

Device-related: Nebulizer

Device-related: Nebulizer

Drug-related

Patient-related

MDI vs Nebulizer

MDI vs Nebulizer

MDI vs Nebulizer

MDI vs Nebulizer

Patient transport from intensive care increases the risk of developing ventilator-associated pneumonia Koller et al, Chest 1997: 112; 765

Continuous in-line nebulizers complicate pressure support ventilation Beaty et al, Chest 1989; 96: 1360

Advantages of MDIs

More about MDIs in mechanical ventilated patients Use of spacer Timing of actuation

MDI-Spacer

MDI-Spacer

MDI-Spacer

MDI-Spacer

MDI-Spacer Dose-response to bronchodilator delivered by metered-dose inhaler in ventilator-supported patients R Dhand et al, AJRCCM 1996; 154: 388

Albuterol delivery in a model of mechanical ventilation. Comparison of metered-dose inhaler and nebulizer efficiency AJRCCM 1995; 152: 1391

Inhalation therapy with metered-dose inhalers and dry powder inhalers in mechanically ventilated patients. Respir Care 2005; 50: 1331– 1334

Options of inhaled drug delivery during NIPPV

Inhalation therapy in ICU

Bronchodilators

Efficiency Inhaled bronchodilator therapy in mechanically ventilated patients AJRCCM 1997; 156: 3 -10

Bronchodilator dosing

Bronchodilator dosing

Bronchodilator dosing

Bronchodilator dosing

Bronchodilators: Use of heliox

Inhaled antibiotics

Inhaled antibiotics Aerosol polymyxin and pneumonia in seriously ill patients NEJM 1975; 293: 471 -475

Inhaled antibiotics Aerosolized colistin for the treatment of nosocomial pneumonia due to multidrug-resistant Gramnegative bacteria in patients without cystic fibrosis Critical Care 2005; 9: 53 -59

Inhaled antibiotics Eradication of endotracheal tube biofilm by nebulised gentamicin ICM 2002; 28: 426

Inhaled antibiotics

Conclusion

References

Efficacy