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Published on: March 30, 2017
Aerosol delivery during mechanical ventilation: from basic techniques to new devices.
1Division of Pulmonary, Critical Care, and Environmental Medicine, Department of Internal Medicine, University of Missouri-Columbia, Columbia, MO 65212, USA. dhandr@health.missouri.edu
Summary
Optimizing aerosol delivery during mechanical ventilation requires careful attention to device type, particle size, and ventilator settings. Proper technique ensures efficient drug delivery, comparable to spontaneous breathing, but further research is needed for non-invasive ventilation.
Area of Science:
- Pulmonary Medicine
- Critical Care
- Respiratory Therapy
Background:
- Pressurized metered-dose inhalers (pMDIs) and nebulizers are standard for aerosol delivery in mechanically ventilated patients.
- A substantial amount of aerosol is lost in the ventilator circuit and artificial airway, reducing effective drug dosage.
- Aerosol delivery dynamics in mechanical ventilation differ significantly from those in spontaneously breathing individuals.
Purpose of the Study:
- To review the English language literature on aerosol delivery during mechanical ventilation.
- To identify key factors influencing aerosol delivery efficiency in this patient population.
- To compare aerosol delivery efficiency between different devices and ventilation modes.
Main Methods:
- Systematic review of the English language literature concerning aerosol delivery during mechanical ventilation.
- Analysis of factors affecting aerosol deposition in the ventilator circuit and artificial airway.
- Comparison of aerosol delivery efficiency with pressurized metered-dose inhalers versus nebulizers.
Main Results:
- Significant variations in aerosol delivery efficiency exist between pMDIs and nebulizers, largely due to administration technique.
- Optimizing aerosol delivery necessitates careful consideration of the aerosol generator, particle size, ventilator circuit conditions, artificial airway, and ventilator parameters.
- Aerosol delivery efficiency during non-invasive positive pressure ventilation (NPPV) is generally lower and less understood than during invasive mechanical ventilation.
Conclusions:
- Optimal administration techniques can render aerosol delivery efficiency during mechanical ventilation comparable to spontaneous breathing.
- Further research is crucial to enhance and optimize aerosol delivery strategies, particularly during NPPV.
- Attention to specific technical factors is paramount for maximizing inhaled drug mass in mechanically ventilated patients.
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