PURPOSE: To describe the practice, knowledge and beliefs about aerosol therapy during mechanical ventilation in an international sample of physicians working in intensive care units (ICU). METHODS: A self-administered survey was emailed to physicians who worked regularly in ICUs. The physicians were identified from the databases of the European and French societies of intensive care medicine and the REVA network. RESULTS: Of the 1,192 responses (15 % response rate), 854 were analyzed. Of the respondents, who represented 611 departments in 70 countries, 99 % reported using aerosol therapy during mechanical ventilation (including non-invasive), 43 % exclusively used nebulizers and 55 % also used metered dose inhalers. Nebulization relied on jet, ultrasonic and vibrating mesh nebulizers (55 %, 44 % and 14 % of respondents, respectively). Bronchodilators and steroids were the most frequently delivered drugs, and 80 % of respondents had a positive opinion concerning nebulized colistin and 30 % reported the use of nebulized antibiotics at least every other month. During nebulization, ventilator settings were never changed by 77 % of respondents, 65 % reported placing a filter on the expiratory limb, and of these 28 % never changed it. Only 22 % of respondents using heated humidifiers reported turning them off during nebulization. Specific knowledge about droplet size and nebulization yield was poor. A majority of respondents (87 %) thought that ultrasonic nebulizers outperform jet nebulizers, while 69 % had no opinion concerning mesh nebulizers. CONCLUSIONS: Aerosol therapy during mechanical ventilation is used by over 95 % of intensivists, mostly for bronchodilator and steroid administration, but also frequently for antibiotics. The current scientific knowledge about optimal implementation seemed infrequently applied, suggesting the need for educational programs and research focusing on a better bench-to-bedside transfer of knowledge.
PURPOSE: To describe the practice, knowledge and beliefs about aerosol therapy during mechanical ventilation in an international sample of physicians working in intensive care units (ICU). METHODS: A self-administered survey was emailed to physicians who worked regularly in ICUs. The physicians were identified from the databases of the European and French societies of intensive care medicine and the REVA network. RESULTS: Of the 1,192 responses (15 % response rate), 854 were analyzed. Of the respondents, who represented 611 departments in 70 countries, 99 % reported using aerosol therapy during mechanical ventilation (including non-invasive), 43 % exclusively used nebulizers and 55 % also used metered dose inhalers. Nebulization relied on jet, ultrasonic and vibrating mesh nebulizers (55 %, 44 % and 14 % of respondents, respectively). Bronchodilators and steroids were the most frequently delivered drugs, and 80 % of respondents had a positive opinion concerning nebulized colistin and 30 % reported the use of nebulized antibiotics at least every other month. During nebulization, ventilator settings were never changed by 77 % of respondents, 65 % reported placing a filter on the expiratory limb, and of these 28 % never changed it. Only 22 % of respondents using heated humidifiers reported turning them off during nebulization. Specific knowledge about droplet size and nebulization yield was poor. A majority of respondents (87 %) thought that ultrasonic nebulizers outperform jet nebulizers, while 69 % had no opinion concerning mesh nebulizers. CONCLUSIONS: Aerosol therapy during mechanical ventilation is used by over 95 % of intensivists, mostly for bronchodilator and steroid administration, but also frequently for antibiotics. The current scientific knowledge about optimal implementation seemed infrequently applied, suggesting the need for educational programs and research focusing on a better bench-to-bedside transfer of knowledge.
Authors: M A Dolovich; N R MacIntyre; P J Anderson; C A Camargo; N Chew; C H Cole; R Dhand; J B Fink; N J Gross; D R Hess; A J Hickey; C S Kim; T B Martonen; D J Pierson; B K Rubin; G C Smaldone Journal: Respir Care Date: 2000-06 Impact factor: 2.258
Authors: Karen E A Burns; Mark Duffett; Michelle E Kho; Maureen O Meade; Neill K J Adhikari; Tasnim Sinuff; Deborah J Cook Journal: CMAJ Date: 2008-07-29 Impact factor: 8.262
Authors: B W Ramsey; H L Dorkin; J D Eisenberg; R L Gibson; I R Harwood; R M Kravitz; D V Schidlow; R W Wilmott; S J Astley; M A McBurnie Journal: N Engl J Med Date: 1993-06-17 Impact factor: 91.245
Authors: Dorisanne D Miller; Mohammad M Amin; Lucy B Palmer; Akbar R Shah; Gerald C Smaldone Journal: Am J Respir Crit Care Med Date: 2003-07-31 Impact factor: 21.405
Authors: Lucy B Palmer; Gerald C Smaldone; John J Chen; Daniel Baram; Tao Duan; Melinda Monteforte; Marie Varela; Ann K Tempone; Thomas O'Riordan; Feroza Daroowalla; Paul Richman Journal: Crit Care Med Date: 2008-07 Impact factor: 7.598
Authors: Ross L Walenga; P Worth Longest; Anubhav Kaviratna; Michael Hindle Journal: J Aerosol Med Pulm Drug Deliv Date: 2017-01-11 Impact factor: 2.849
Authors: Garyphallia Poulakou; Dimitrios K Matthaiou; David P Nicolau; Georgios Siakallis; George Dimopoulos Journal: Drugs Date: 2017-09 Impact factor: 9.546
Authors: Marina Attanasi; Simone Pasini; Antonio Caronni; Giulia Michela Pellegrino; Paola Faverio; Sabrina Di Pillo; Matteo Maria Cimino; Giuseppe Cipolla; Francesco Chiarelli; Stefano Centanni; Giuseppe Francesco Sferrazza Papa Journal: Respiration Date: 2020-08-05 Impact factor: 3.580
Authors: David M P van Meenen; Sophia M van der Hoeven; Jan M Binnekade; Corianne A J M de Borgie; Maruschka P Merkus; Frank H Bosch; Henrik Endeman; Jasper J Haringman; Nardo J M van der Meer; Hazra S Moeniralam; Mathilde Slabbekoorn; Marcella C A Muller; Willemke Stilma; Bart van Silfhout; Ary Serpa Neto; Hans F M Ter Haar; Jan Van Vliet; Jan Willem Wijnhoven; Janneke Horn; Nicole P Juffermans; Paolo Pelosi; Marcelo Gama de Abreu; Marcus J Schultz; Frederique Paulus Journal: JAMA Date: 2018-03-13 Impact factor: 56.272