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01-02-2016 | Original

Aerosol therapy in intensive and intermediate care units: prospective observation of 2808 critically ill patients

Authors: Stephan Ehrmann, Ferran Roche-Campo, Laetitia Bodet-Contentin, Keyvan Razazi, Jonathan Dugernier, Josep Trenado-Alvarez, Alexis Donzeau, François Vermeulen, David Thévoz, Metaxia Papanikolaou, Antoine Edelson, Héctor León Yoshido, Lise Piquilloud, Karim Lakhal, Carlos Lopes, Carlos Vicent, Arnaud Desachy, Gabriela Apiou-Sbirlea, Daniel Isabey, Laurent Brochard, Reva Research Network, AT@ICU Study Group

Published in: Intensive Care Medicine | Issue 2/2016

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.

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Title: Aerosol therapy in intensive and intermediate care units: prospective observation of 2808 critically ill patients
Authors: Stephan Ehrmann
Ferran Roche-Campo
Laetitia Bodet-Contentin
Keyvan Razazi
Jonathan Dugernier
Josep Trenado-Alvarez
Alexis Donzeau
François Vermeulen
David Thévoz
Metaxia Papanikolaou
Antoine Edelson
Héctor León Yoshido
Lise Piquilloud
Karim Lakhal
Carlos Lopes
Carlos Vicent
Arnaud Desachy
Gabriela Apiou-Sbirlea
Daniel Isabey
Laurent Brochard
Reva Research Network
AT@ICU Study Group
Publication date: 01-02-2016
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 2/2016
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-015-4114-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Aerosol therapy in intensive and intermediate care units: prospective observation of 2808 critically ill patients

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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