Key considerations on nebulization of antimicrobial agents to mechanically ventilated patients

Rello, J., Rouby, J. J., Sole-Lleonart, C., Chastre, J., Blot, S., Luyt, C. E., Riera, J., Vos, M. C., Monsel, A., Dhanani, J. and Roberts, J. A. (2017) Key considerations on nebulization of antimicrobial agents to mechanically ventilated patients. Clinical Microbiology and Infection, 23 9: 640-646. doi:10.1016/j.cmi.2017.03.018

Author Rello, J.
Rouby, J. J.
Sole-Lleonart, C.
Chastre, J.
Blot, S.
Luyt, C. E.
Riera, J.
Vos, M. C.
Monsel, A.
Dhanani, J.
Roberts, J. A.
Title Key considerations on nebulization of antimicrobial agents to mechanically ventilated patients
Journal name Clinical Microbiology and Infection   Check publisher's open access policy
ISSN 1198-743X
Publication date 2017-09-01
Year available 2017
Sub-type Article (original research)
DOI 10.1016/j.cmi.2017.03.018
Open Access Status Not yet assessed
Volume 23
Issue 9
Start page 640
End page 646
Total pages 7
Place of publication Langford Lane, Oxford, United Kingdom
Publisher Elsevier
Language eng
Subject 2726 Microbiology (medical)
2725 Infectious Diseases
Abstract Nebulized antibiotics have an established role in patients with cystic fibrosis or bronchiectasis. Their potential benefit to treat respiratory infections in mechanically ventilated patients is receiving increasing interest. In this consensus statement of the European Society of Clinical Microbiology and Infectious Diseases, the body of evidence of the therapeutic utility of aerosolized antibiotics in mechanically ventilated patients was reviewed and resulted in the following recommendations: Vibrating-mesh nebulizers should be preferred to jet or ultrasonic nebulizers. To decrease turbulence and limit circuit and tracheobronchial deposition, we recommend: (a) the use of specifically designed respiratory circuits avoiding sharp angles and characterized by smooth inner surfaces, (b) the use of specific ventilator settings during nebulization including use of a volume controlled mode using constant inspiratory flow, tidal volume 8 mL/kg, respiratory frequency 12 to 15 bpm, inspiratory: expiratory ratio 50%, inspiratory pause 20% and positive end-expiratory pressure 5 to 10 cm H2O and (c) the administration of a short-acting sedative agent if coordination between the patient and the ventilator is not obtained, to avoid patient's flow triggering and episodes of peak decelerating inspiratory flow. A filter should be inserted on the expiratory limb to protect the ventilator flow device and changed between each nebulization to avoid expiratory flow obstruction. A heat and moisture exchanger and/ or conventional heated humidifier should be stopped during the nebulization period to avoid a massive loss of aerosolized particles through trapping and condensation. If these technical requirements are not followed, there is a high risk of treatment failure and adverse events in mechanically ventilated patients receiving nebulized antibiotics for pneumonia. (C) 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Keyword Aminoglycosides
Antibiotic aerosolization
Multidrug-resistant organisms
Ventilator-associated pneumonia
Ventilator-associated tracheobronchitis
Lung-Tissue Concentrations
Critically-Ill Patients
Aerosolized Antibiotics
Healthy Lungs
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID 16/fucap
Institutional Status UQ

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