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Open Access 01-12-2017 | Research

Aerosol delivery during invasive mechanical ventilation: a systematic review

Authors: Jonathan Dugernier, Stephan Ehrmann, Thierry Sottiaux, Jean Roeseler, Xavier Wittebole, Thierry Dugernier, François Jamar, Pierre-François Laterre, Gregory Reychler

Published in: Critical Care | Issue 1/2017

Abstract

Background

This systematic review aimed to assess inhaled drug delivery in mechanically ventilated patients or in animal models. Whole lung and regional deposition and the impact of the ventilator circuit, the artificial airways and the administration technique for aerosol delivery were analyzed.

Methods

In vivo studies assessing lung deposition during invasive mechanical ventilation were selected based on a systematic search among four databases. Two investigators independently assessed the eligibility and the risk of bias.

Results

Twenty-six clinical and ten experimental studies were included. Between 30% and 43% of nominal drug dose was lost to the circuit in ventilated patients. Whole lung deposition of up to 16% and 38% of nominal dose (proportion of drug charged in the device) were reported with nebulizers and metered-dose inhalers, respectively. A penetration index inferior to 1 observed in scintigraphic studies indicated major proximal deposition. However, substantial concentrations of antibiotics were measured in the epithelial lining fluid (887 (406–12,819) μg/mL of amikacin) of infected patients and in sub-pleural specimens (e.g., 197 μg/g of amikacin) dissected from infected piglets, suggesting a significant distal deposition. The administration technique varied among studies and may explain a degree of the variability of deposition that was observed.

Conclusions

Lung deposition was lower than 20% of nominal dose delivered with nebulizers and mostly occurred in proximal airways. Further studies are needed to link substantial concentrations of antibiotics in infected pulmonary fluids to pulmonary deposition. The administration technique with nebulizers should be improved in ventilated patients in order to ensure an efficient but safe, feasible and reproducible technique.

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Title: Aerosol delivery during invasive mechanical ventilation: a systematic review
Authors: Jonathan Dugernier
Stephan Ehrmann
Thierry Sottiaux
Jean Roeseler
Xavier Wittebole
Thierry Dugernier
François Jamar
Pierre-François Laterre
Gregory Reychler
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/s13054-017-1844-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Aerosol delivery during invasive mechanical ventilation: a systematic review

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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