Aerosolized therapy for ventilator-assisted patients

Although aerosols, especially bronchodilators, are routinely administered to ventilator-assisted patients, the practice lacks scientific proof that it improves the outcome of respiratory failure. Using sensitive instruments, investigators have found that aerosolized bronchodilators lead to improvement in airflow immediately following the treatment; however, no study to date has correlated short-term improvement in pulmonary function to a decreased incidence of barotrauma or reduced need for mechanical ventilation. Multiple variables interfere with optimum delivery of aerosols to ventilator-assisted patients, including the endotracheal tube, patient and ventilator breathing pattern, and the inefficiency of nebulizer systems. Recent evidence suggests that if aerosols are used to treat intubated patients, metered-dose inhalers are the devices of choice in terms of cost and efficacy.