Intratracheal administration of antimicrobial agents in mechanically ventilated adults: an international survey on delivery practices and safety

Sole-Lleonart, Candela, Rouby, Jean-Jacques, Chastre, Jean, Poulakou, Garyfallia, Palmer, Lucy B., Blot, Stijn, Felton, Tim, Bassetti, Matteo, Luyt, Charles-Eduard, Pereira, Joao Manuel, Riera, Jordi, Welte, Tobias, Roberts, Jason A. and Rello, Jordi (2016) Intratracheal administration of antimicrobial agents in mechanically ventilated adults: an international survey on delivery practices and safety. Respiratory Care, 61 8: 1008-1014. doi:10.4187/respcare.04519


Author Sole-Lleonart, Candela
Rouby, Jean-Jacques
Chastre, Jean
Poulakou, Garyfallia
Palmer, Lucy B.
Blot, Stijn
Felton, Tim
Bassetti, Matteo
Luyt, Charles-Eduard
Pereira, Joao Manuel
Riera, Jordi
Welte, Tobias
Roberts, Jason A.
Rello, Jordi
Title Intratracheal administration of antimicrobial agents in mechanically ventilated adults: an international survey on delivery practices and safety
Journal name Respiratory Care   Check publisher's open access policy
ISSN 1943-3654
0020-1324
Publication date 2016-08-01
Sub-type Article (original research)
DOI 10.4187/respcare.04519
Open Access Status Not yet assessed
Volume 61
Issue 8
Start page 1008
End page 1014
Total pages 7
Place of publication Irving, TX, United States
Publisher Daedalus Enterprises
Collection year 2017
Language eng
Formatted 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.
Keyword Aerosol therapy
Antibiotics
Delivery device
Nebulizer
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

 
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