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Intensive Care Med. 2016 Feb;42(2):192-201. doi: 10.1007/s00134-015-4114-5. Epub 2015 Nov 24.

Aerosol therapy in intensive and intermediate care units: prospective observation of 2808 critically ill patients.

Collaborators (145)

Abdel-Hadi H, Aguilar-Alonso E, Aguirre-Bermeo H, Akbaş T, Anchorena-Gonzalez R, Antunes N, Branco C, Apodaca J, Argaud L, Arnal JM, Arteta D, Aubrey A, Badiola-Villa H, Barberet G, Bauer T, Befort P, Belskiy V, Benslama A, Berger P, Berger P, Bergounioux J, Beuret P, Bianco H, Bironneau V, Bitondo MM, Blet A, Bodet-Contentin L, Boubaker C, Bouhon S, Boulain T, Bulpa P, Carrasco GA, Castanares-Zapatero D, Cesio C, Chen Q, Costa P, Curiel-Balsera E, Daroui I, de Capadocia-Rosell J, Delgado-Bravo A, Dellamonica J, Desachy A, Donzeau A, Duan Y, Yang X, Dugernier J, Dupont H, Duwat A, Edelson A, Ehrmann S, Faheem M, Fernandez-Ugidos P, Roca RF, Frat JP, Gainnier M, Gamelin A, Garcia-Delgado H, Gardan V, Gimeno M, Gomez-Aduviri O, Goncalve O, Gu D, Gutierrez-Rubio J, Haggenmacher C, Haibin N, Hanane E, Frades SH, Heines S, Hilin Y, Huet C, Hurel D, Italiano S, Jammoussi A, Jannel C, Jimenez-Delgado J, Benito D, Jochmans S, Just B, Karakurt S, Ladislav B, Lage-Cendon L, Lakhal K, Lei G, Yoshido HL, Lidia D, Lobato-Madueno F, Lopes C, Lopez-Herce J, Lopez-Lachira L, Lu Q, Mabilat C, Magdy K, Mallor-Bonet T, Marchalot A, Mariano S, Mateu P, Mendes R, Messika J, Micaelo F, Millan-Castilla F, Mohamed B, Molero E, Montes-de Oca O, Mora G, Muller G, Nava S, Naveen J, Papanikolaou M, Parrilla FJ, Parsons A, Patel R, Payen V, Pereira-Loureiro M, Perez-Aizcorreta O, Perez Marquez M, Piquilloud L, Pradeep D, Quan G, Quesada-Bellver B, Rami S, Razazi K, Rialp G, Rigaud JP, Roche-Campo F, Romnee A, Rovira A, Sanchez-Garcia J, Sanson JM, Sayagues L, Vieules VS, Spasojevic S, Mohamed MI, Thévoz D, Thille AW, Tonduangu DK, Trenado-Alvarez J, Valente J, Vermeulen F, Vicent C, Xiaoyun F, Zalba-Etayo B, Zhang X, Zhang S, Zhu F, Zogheib E.

Author information

1
Institut National de la Santé et de la Recherche Médicale, UMR 955 and Centre National de la Recherche Scientifique, ERL 7240, Equipe de Biomécanique Cellulaire et Respiratoire, Université Paris Est, Créteil, France. stephanehrmann@gmail.com.
2
Réanimation Polyvalente, Centre Hospitalier Régional et Universitaire de Tours, F37044, Tours Cedex 9, France. stephanehrmann@gmail.com.
3
Institut National de la Santé et de la Recherche Médicale, Centre d'Étude des Pathologies Respiratoires, UMR 1100, Aérosolthérapie et Biomédicaments à Visée Respiratoire, Faculté de Medecine, Université François Rabelais, Tours, France. stephanehrmann@gmail.com.
4
Medicina Intensiva, Hospital Verge de la Cinta, Tortosa, Tarragona, Spain.
5
Réanimation Polyvalente, Centre Hospitalier Régional et Universitaire de Tours, F37044, Tours Cedex 9, France.
6
Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris and Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
7
Assistance Publique-Hôpitaux de Paris, GHU Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Groupe de Recherche CARMAS, Créteil, France.
8
Intensive Care Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
9
Servei Medicina Intensiva, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain.
10
Réanimation Médicale et Médecine Hyperbare, Centre Hospitalier Régional Universitaire d'Angers, Angers, France.
11
Department of Intensive Care, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland.
12
Médecine Intensive Adulte et Centre des Brulés, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
13
Intensive Care Unit, Hippocrateion General Hospital of Athens, Athens, Greece.
14
Réanimation, Centre Hospitalier du Taaone, Pirae, French Polynesia.
15
Medicina Intensiva, Hospital Nacional Edgardo Rebagliati Martins Essalud, Lima, Peru.
16
Réanimation Chirurgicale Polyvalente, Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Régional Universitaire de Nantes, F44093, Nantes, France.
17
UCIR-Pulmonology, Hospital de Santa Maria, CHLN, Lisbon, Portugal.
18
Intensive Care Unit, Hospital Lluis Alcanyis, Xativa, Valencia, Spain.
19
Service de Réanimation, Centre Hospitalier d'Angoulême, Angoulême, France.
20
Institut National de la Santé et de la Recherche Médicale, UMR 955 and Centre National de la Recherche Scientifique, ERL 7240, Equipe de Biomécanique Cellulaire et Respiratoire, Université Paris Est, Créteil, France.
21
Department of Dermatology, Harvard Medical School, Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, USA.
22
Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.
23
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.

Abstract

PURPOSE:

Unlike in the outpatient setting, delivery of aerosols to critically ill patients may be considered complex, particularly in ventilated patients, and benefits remain to be proven. Many factors influence aerosol delivery and recommendations exist, but little is known about knowledge translation into clinical practice.

METHODS:

Two-week cross-sectional study to assess the prevalence of aerosol therapy in 81 intensive and intermediate care units in 22 countries. All aerosols delivered to patients breathing spontaneously, ventilated invasively or noninvasively (NIV) were recorded, and drugs, devices, ventilator settings, circuit set-up, humidification and side effects were noted.

RESULTS:

A total of 9714 aerosols were administered to 678 of the 2808 admitted patients (24 %, CI95 22-26 %), whereas only 271 patients (10 %) were taking inhaled medication before admission. There were large variations among centers, from 0 to 57 %. Among intubated patients 22 % (n = 262) received aerosols, and 50 % (n = 149) of patients undergoing NIV, predominantly (75 %) inbetween NIV sessions. Bronchodilators (n = 7960) and corticosteroids (n = 1233) were the most frequently delivered drugs (88 % overall), predominantly but not exclusively (49 %) administered to patients with chronic airway disease. An anti-infectious drug was aerosolized 509 times (5 % of all aerosols) for nosocomial infections. Jet-nebulizers were the most frequently used device (56 %), followed by metered dose inhalers (23 %). Only 106 (<1 %) mild side effects were observed, despite frequent suboptimal set-ups such as an external gas supply of jet nebulizers for intubated patients.

CONCLUSIONS:

Aerosol therapy concerns every fourth critically ill patient and one-fifth of ventilated patients.

KEYWORDS:

Administration, inhalation [MeSH]; Anti-bacterial agents [MeSH]; Bronchodilator agents [MeSH]; Metered dose inhalers [MeSH]; Nebulizers and vaporizers [MeSH]; Respiration, artificial [MeSH]

PMID:
26602786
DOI:
10.1007/s00134-015-4114-5
[Indexed for MEDLINE]

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