Stephan Ehrmann1,2,3, Ferran Roche-Campo4, Laetitia Bodet-Contentin5,6, Keyvan Razazi7, Jonathan Dugernier8, Josep Trenado-Alvarez9, Alexis Donzeau10, François Vermeulen11, David Thévoz12, Metaxia Papanikolaou13, Antoine Edelson14, Héctor León Yoshido15, Lise Piquilloud10,12, Karim Lakhal16, Carlos Lopes17, Carlos Vicent18, Arnaud Desachy19, Gabriela Apiou-Sbirlea20,21, Daniel Isabey20, Laurent Brochard22,23. 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.
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.
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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
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Authors: Jayesh A Dhanani; Jeremy Cohen; Suzanne L Parker; Hak-Kim Chan; Patricia Tang; Benjamin J Ahern; Adeel Khan; Manoj Bhatt; Steven Goodman; Sara Diab; Jivesh Chaudhary; Jeffrey Lipman; Steven C Wallis; Adrian Barnett; Michelle Chew; John F Fraser; Jason A Roberts Journal: Intensive Care Med Exp Date: 2018-07-11