Nebulization of Antiinfective Agents in Invasively Mechanically Ventilated Adults: A Systematic Review and Meta-analysis.

Détails

ID Serval
serval:BIB_C6C28F61D269
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Nebulization of Antiinfective Agents in Invasively Mechanically Ventilated Adults: A Systematic Review and Meta-analysis.
Périodique
Anesthesiology
Auteur(s)
Solé-Lleonart C., Rouby J.J., Blot S., Poulakou G., Chastre J., Palmer L.B., Bassetti M., Luyt C.E., Pereira J.M., Riera J., Felton T., Dhanani J., Welte T., Garcia-Alamino J.M., Roberts J.A., Rello J.
ISSN
1528-1175 (Electronic)
ISSN-L
0003-3022
Statut éditorial
Publié
Date de publication
05/2017
Peer-reviewed
Oui
Volume
126
Numéro
5
Pages
890-908
Langue
anglais
Notes
Publication types: Journal Article ; Meta-Analysis ; Review
Publication Status: ppublish
Résumé
Nebulization of antiinfective agents is a common but unstandardized practice in critically ill patients.
A systematic review of 1,435 studies was performed in adults receiving invasive mechanical ventilation. Two different administration strategies (adjunctive and substitute) were considered clinically relevant. Inclusion was restricted to studies using jet, ultrasonic, and vibrating-mesh nebulizers. Studies involving children, colonized-but-not-infected adults, and cystic fibrosis patients were excluded.
Five of the 11 studies included had a small sample size (fewer than 50 patients), and only 6 were randomized. Diversity of case-mix, dosage, and devices are sources of bias. Only a few patients had severe hypoxemia. Aminoglycosides and colistin were the most common antibiotics, being safe regarding nephrotoxicity and neurotoxicity, but increased respiratory complications in 9% (95% CI, 0.01 to 0.18; I = 52%), particularly when administered to hypoxemic patients. For tracheobronchitis, a significant decrease in emergence of resistance was evidenced (risk ratio, 0.18; 95% CI, 0.05 to 0.64; I = 0%). Similar findings were observed in pneumonia by susceptible pathogens, without improvement in mortality or ventilation duration. In pneumonia caused by resistant pathogens, higher clinical resolution (odds ratio, 1.96; 95% CI, 1.30 to 2.96; I = 0%) was evidenced. These findings were not consistently evidenced in the assessment of efficacy against pneumonia caused by susceptible pathogens.
Performance of randomized trials evaluating the impact of nebulized antibiotics with more homogeneous populations, standardized drug delivery, predetermined clinical efficacy, and safety outcomes is urgently required. Infections by resistant pathogens might potentially have higher benefit from nebulized antiinfective agents. Nebulization, without concomitant systemic administration of the drug, may reduce nephrotoxicity but may also be associated with higher risk of respiratory complications.

Mots-clé
Anti-Bacterial Agents/administration & dosage, Anti-Bacterial Agents/therapeutic use, Critical Illness, Humans, Intensive Care Units, Nebulizers and Vaporizers, Pneumonia, Ventilator-Associated/drug therapy, Respiration, Artificial/adverse effects
Pubmed
Web of science
Création de la notice
07/03/2017 18:42
Dernière modification de la notice
20/08/2019 15:42
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