How Should Aerosols Be Delivered During Invasive Mechanical Ventilation?

Area of Science:

• Respiratory Medicine
• Pulmonary Pharmacology

Background:

• Aerosol delivery to mechanically ventilated patients presents unique challenges compared to spontaneously breathing individuals.
• Optimizing aerosol therapy requires careful consideration of factors influencing drug delivery and lung deposition.

Purpose of the Study:

• To review the challenges and considerations for aerosol delivery in mechanically ventilated patients.
• To discuss various aerosol delivery devices and agents used in this population.
• To highlight the goals of inhalation therapy and the need for standardized best practices.

Main Methods:

• Review of commonly used aerosol delivery devices including pressurized metered-dose inhalers and various nebulizers (jet, ultrasonic, vibrating mesh).
• Discussion of other potential devices like dry powder inhalers and soft mist inhalers for in-line use.
• Overview of various inhaled agents administered during mechanical ventilation.

Main Results:

• Successful aerosol delivery depends on numerous factors affecting patient drug inhalation.
• Multiple devices and agents are available for aerosol therapy in mechanically ventilated patients.
• Significant variation in clinical practice necessitates the development of guidelines.

Conclusions:

• Achieving optimal inhalation therapy requires assuring drug delivery, optimizing lung deposition, ensuring consistent and reproducible dosing, and employing feasible, safe, and cost-effective methods.
• Standardized guidelines are crucial to address variations in clinical practice for aerosol administration in mechanically ventilated patients.