Compliance of Aerosol Therapy with Evidence-based Guideline and Cost Incurred in Adult Critically-ill Patients: A...

Aerosol therapy is widely used in intensive care units (ICUs) for managing respiratory conditions. However, non-adherence to evidence-based guidelines can compromise outcomes and increase healthcare costs. This study evaluated the compliance of aerosol therapy with the "Indian Guidelines on Nebulization Therapy" and the cost incurred in critically ill patients.

A prospective observational study was conducted in 307 adult patients across the ICUs of a tertiary care hospital during a six-month study period. Analysis was performed using the chi-square test and the Wilcoxon rank-sum test in RStudio (version 4-4.3, 2024). Multivariate logistic regression identified independent predictors of compliance.

Of the 307 ICU patients analyzed, 64.5% were male, with an average age of 57±16 years. Jet nebulizers were used in 91.5% of cases. Bronchodilators (47.13%) and corticosteroids (35%) were widely used classes of drugs. Compliance of drug therapy with evidence-based guidelines varied significantly by duration of ICU stay (P = 0.0062) and by ICU category (P = 0.0005). Drug compliance was higher in critical care and neurology ICUs [odds ratio (OR): 6.500, P = 0.0001; OR: 4.574, P = 0.005]. Administration compliance was significantly associated with the diagnosis category (P = 0.00186) and was higher among patients with non-respiratory diagnoses (OR: 4.96, P =0.0068). Adherence to guidelines for drug therapy significantly lowered costs (P = 0.0103).

Targeted interventions, protocol standardization, and staff training are needed to enhance compliance, optimize patient care, and control aerosol-related expenditures. Clinically, these findings highlight that adherence to evidence-based aerosol therapy not only enhances patient outcomes but also reduces ICU expenditure, thereby supporting integration into routine clinical practice.