Treatment with aerosols in mechanically ventilated patients: is it worthwhile?

Aerosol medications are commonly used in mechanically ventilated patients. Several classes of drugs with different properties and indications may be given by inhalation. In all cases, compared with the systemic route, the inhaled therapy has the main advantage that for a given therapeutic response, the drug dose is several-fold lower, while the systemic absorption is negligible, thus the side effects are greatly minimized. In addition, for some medications the systemic route either causes non-acceptable side effects or results in considerably inferior therapeutic response, rendering the inhaled route the method of choice of drug administration. Bronchodilators, corticosteroids, vasoactive drugs, surfactants, antibiotics, helium and perfluorocarbons are the medications that can be given by inhalation during mechanical ventilation. Some of those represent part of the standard treatment for various groups of mechanically ventilated patients, while the role of others has not been well established yet.