Aerosol delivery to intubated patients.

INTRODUCTION: Approximately 20 million patients are intubated in the USA each year, primarily for the administration of drugs. While the vast majority of these medications are administered as gas or instilled, there is a growing practice of aerosol administration to intubated patients, often associated with mechanical ventilation. As no drugs have been approved for aerosol administration to intubated infants or adults, much of these practices are technically off-label. AREAS COVERED: History and advances in aerosol delivery with methods to determine delivery, with variables that impact delivery and the evolution of new technology and techniques. A literature search was undertaken using several databases including Cochrane, PubMed, Medline, Cinahl and Science Direct, covered materials from 1885 through January 2013. EXPERT OPINION: As aerosol deposition has increased with newer technologies from 1 - 3% up to 30 - 60%, there exists an opportunity to develop drugs to better treat these sickest of patients and address the current unmet medical need.