Key considerations on nebulization of antimicrobial agents to mechanically ventilated patients
Autor: | Jean-Jacques Rouby, Jordi Rello, MC Vos, Candela Solé-Lleonart, Jason A. Roberts, Stijn Blot, Antoine Monsel, Jayesh Dhanani, Jordi Riera, Charles-Edouard Luyt, Jean Chastre |
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Rok vydání: | 2017 |
Předmět: |
Microbiology (medical)
Consensus Cystic fibrosis 03 medical and health sciences 0302 clinical medicine Anti-Infective Agents medicine Humans Respiratory system Tidal volume Aerosolization Bronchiectasis business.industry Nebulizers and Vaporizers Ventilator-associated pneumonia Pneumonia Ventilator-Associated 030208 emergency & critical care medicine General Medicine medicine.disease Respiration Artificial Pneumonia Infectious Diseases 030228 respiratory system Heat and moisture exchanger Anesthesia business |
Zdroj: | Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 23(9) |
ISSN: | 1469-0691 |
Popis: | Nebulized antibiotics have an established role in patients with cystic fibrosis or bronchiectasis. Their potential benefit to treat respiratory infections in mechanically ventilated patients is receiving increasing interest. In this consensus statement of the European Society of Clinical Microbiology and Infectious Diseases, the body of evidence of the therapeutic utility of aerosolized antibiotics in mechanically ventilated patients was reviewed and resulted in the following recommendations: Vibrating-mesh nebulizers should be preferred to jet or ultrasonic nebulizers. To decrease turbulence and limit circuit and tracheobronchial deposition, we recommend: (a) the use of specifically designed respiratory circuits avoiding sharp angles and characterized by smooth inner surfaces, (b) the use of specific ventilator settings during nebulization including use of a volume controlled mode using constant inspiratory flow, tidal volume 8 mL/kg, respiratory frequency 12 to 15 bpm, inspiratory:expiratory ratio 50%, inspiratory pause 20% and positive end-expiratory pressure 5 to 10 cm H2O and (c) the administration of a short-acting sedative agent if coordination between the patient and the ventilator is not obtained, to avoid patient's flow triggering and episodes of peak decelerating inspiratory flow. A filter should be inserted on the expiratory limb to protect the ventilator flow device and changed between each nebulization to avoid expiratory flow obstruction. A heat and moisture exchanger and/or conventional heated humidifier should be stopped during the nebulization period to avoid a massive loss of aerosolized particles through trapping and condensation. If these technical requirements are not followed, there is a high risk of treatment failure and adverse events in mechanically ventilated patients receiving nebulized antibiotics for pneumonia. |
Databáze: | OpenAIRE |
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