Key considerations on nebulization of antimicrobial agents to mechanically ventilated patients.
Details
Serval ID
serval:BIB_5B22591A4943
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Key considerations on nebulization of antimicrobial agents to mechanically ventilated patients.
Journal
Clinical microbiology and infection
ISSN
1469-0691 (Electronic)
ISSN-L
1198-743X
Publication state
Published
Issued date
09/2017
Peer-reviewed
Oui
Volume
23
Number
9
Pages
640-646
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
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 H <sub>2</sub> O 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.
Keywords
Anti-Infective Agents/administration & dosage, Anti-Infective Agents/therapeutic use, Consensus, Humans, Nebulizers and Vaporizers, Pneumonia, Ventilator-Associated/drug therapy, Pneumonia, Ventilator-Associated/prevention & control, Respiration, Artificial, Aminoglycosides, Antibiotic aerosolization, Colistin, Multidrug-resistant organisms, Nebulizers, Ventilator-associated pneumonia, Ventilator-associated tracheobronchitis
Pubmed
Web of science
Create date
04/04/2017 17:37
Last modification date
20/08/2019 14:14