Candela Solé-Lleonart1, Jean-Jacques Rouby2, Jean Chastre3, Garyfallia Poulakou4, Lucy B Palmer5, Stijn Blot6, Tim Felton7, Matteo Bassetti8, Charles-Eduard Luyt3, Joao Manuel Pereira9, Jordi Riera10, Tobias Welte11, Jason A Roberts12, Jordi Rello13. 1. University of Toronto, UHN & Mount Sinai Hospital, Toronto, Canada and Universitat Autonoma de Barcelona, Barcelona, Spain. 2. Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie (UPMC) of Paris 6, Paris, France. 3. Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie of Paris, Paris, France. 4. 4th Department of Internal Medicine, Athens University School of Medicine, Attikon University General Hospital, Athens, Greece. 5. Pulmonary, Critical Care, and Sleep Division, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York. 6. Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium. 7. Acute Intensive Care Unit, University Hospital of South Manchester, Manchester, United Kingdom. 8. Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy. 9. Emergency and Intensive Care Department, Centro Hospitalar S João EPE, University of Porto, Porto, Portugal. 10. Critical Care Department, Vall d'Hebron University Hospital, Centro Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Vall d'Hebron Institute of Research, Barcelona, Spain. 11. Department of Pulmonary Medicine, Hannover Medical School, Hannover, Germany. 12. Burns Trauma and Critical Care Research Centre, University of Queensland, Butterfield Street, Herston, Brisbane, Australia. 13. Vall d'Hebron University Hospital, CIBERES, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain. jrello@crips.es.
Abstract
BACKGROUND: Intratracheal antibiotic administration is increasingly used for treating respiratory infections. Limited information is available on delivery devices, techniques, and safety. METHODS: An online survey on intratracheal administration of anti-infective agents in mechanically ventilated adults was answered by health-care workers from 192 ICUs to assess the most commonly used devices, current delivery practices, and safety issues. We investigated whether ICU usage experience (≥3 y) impacted its performance. RESULTS: Intratracheal antibiotic administration was a current practice in 87 ICUs (45.3%), with 40 (46%) having experience with the technique (≥3 y). Sixty-six (78.6%) of 84 health-care workers reported avoiding intratracheal antibiotic administration due to an absence of evidence-based guidelines (78.6%). Jet nebulizers were the most commonly used devices for delivery, in 24 less experienced ICUs (27.6%) and in 18 (20.7%) experienced ICUs. Direct tracheal instillation (6; 6.9%) was still considered for drug prescription in 12 ICUs (6.9%). More experience resulted in neither greater adherence to measures improving the drug's delivery efficiency (93 measures in the experienced group; 27.9%) nor a greater adoption of measures to increase safety. Indeed, the expiratory filter was changed after each nebulization in only 2 experienced ICUs (6.9%), whereas 15 (51.7%) changed it daily instead. CONCLUSIONS: Intratracheal antibiotic administration is a common therapeutic modality in ICUs, but inadequate practices were widely encountered, independent of the level of experience with the technique. This suggests a need to develop standardization to reduce variability and improve safety and efficacy.
BACKGROUND: Intratracheal antibiotic administration is increasingly used for treating respiratory infections. Limited information is available on delivery devices, techniques, and safety. METHODS: An online survey on intratracheal administration of anti-infective agents in mechanically ventilated adults was answered by health-care workers from 192 ICUs to assess the most commonly used devices, current delivery practices, and safety issues. We investigated whether ICU usage experience (≥3 y) impacted its performance. RESULTS: Intratracheal antibiotic administration was a current practice in 87 ICUs (45.3%), with 40 (46%) having experience with the technique (≥3 y). Sixty-six (78.6%) of 84 health-care workers reported avoiding intratracheal antibiotic administration due to an absence of evidence-based guidelines (78.6%). Jet nebulizers were the most commonly used devices for delivery, in 24 less experienced ICUs (27.6%) and in 18 (20.7%) experienced ICUs. Direct tracheal instillation (6; 6.9%) was still considered for drug prescription in 12 ICUs (6.9%). More experience resulted in neither greater adherence to measures improving the drug's delivery efficiency (93 measures in the experienced group; 27.9%) nor a greater adoption of measures to increase safety. Indeed, the expiratory filter was changed after each nebulization in only 2 experienced ICUs (6.9%), whereas 15 (51.7%) changed it daily instead. CONCLUSIONS: Intratracheal antibiotic administration is a common therapeutic modality in ICUs, but inadequate practices were widely encountered, independent of the level of experience with the technique. This suggests a need to develop standardization to reduce variability and improve safety and efficacy.
Authors: Garyphallia Poulakou; Dimitrios K Matthaiou; David P Nicolau; Georgios Siakallis; George Dimopoulos Journal: Drugs Date: 2017-09 Impact factor: 9.546
Authors: Jayesh Dhanani; John F Fraser; Hak-Kim Chan; Jordi Rello; Jeremy Cohen; Jason A Roberts Journal: Crit Care Date: 2016-10-07 Impact factor: 9.097