Aerosol therapy in intensive and intermediate care units: prospective observation of 2808 critically ill patients |
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| 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 |
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| Affiliation: | 1.Institut National de la Santé et de la Recherche Médicale, UMR 955 and Centre National de la Recherche Scientifique, ERL 7240, Equipe de Biomécanique Cellulaire et Respiratoire,Université Paris Est,Créteil,France;2.Réanimation Polyvalente,Centre Hospitalier Régional et Universitaire de Tours,Tours Cedex 9,France;3.Institut National de la Santé et de la Recherche Médicale, Centre d’étude des Pathologies Respiratoires, UMR 1100, Aérosolthérapie et Biomédicaments à Visée Respiratoire, Faculté de Medecine,Université Fran?ois Rabelais,Tours,France;4.Medicina Intensiva,Hospital Verge de la Cinta,Tortosa,Spain;5.Réanimation Médicale, H?pital Cochin, Assistance Publique-H?pitaux de Paris and Faculté de Médecine,Université Paris Descartes,Paris,France;6.Assistance Publique-H?pitaux de Paris, GHU Henri Mondor, DHU A-TVB, Service de Réanimation Médicale,Groupe de Recherche CARMAS,Créteil,France;7.Intensive Care Unit,Cliniques Universitaires Saint-Luc,Brussels,Belgium;8.Servei Medicina Intensiva, Hospital Universitari Mutua Terrassa,Universitat de Barcelona,Terrassa,Spain;9.Réanimation Médicale et Médecine Hyperbare,Centre Hospitalier Régional Universitaire d’Angers,Angers,France;10.Department of Intensive Care,H?pitaux Universitaires de Genève,Geneva,Switzerland;11.Médecine Intensive Adulte et Centre des Brulés,Centre Hospitalier Universitaire Vaudois,Lausanne,Switzerland;12.Intensive Care Unit,Hippocrateion General Hospital of Athens,Athens,Greece;13.Réanimation,Centre Hospitalier du Taaone,Pirae,French Polynesia;14.Medicina Intensiva,Hospital Nacional Edgardo Rebagliati Martins Essalud,Lima,Peru;15.Réanimation Chirurgicale Polyvalente, Service d’Anesthésie-Réanimation, H?pital La?nnec,Centre Hospitalier Régional Universitaire de Nantes,Nantes,France;16.UCIR-Pulmonology,Hospital de Santa Maria, CHLN,Lisbon,Portugal;17.Intensive Care Unit,Hospital Lluis Alcanyis,Xativa,Spain;18.Service de Réanimation,Centre Hospitalier d’Angoulême,Angoulême,France;19.Department of Dermatology, Harvard Medical School,Wellman Center for Photomedicine, Massachusetts General Hospital,Boston,USA;20.Keenan Research Centre, Li Ka Shing Knowledge Institute,St Michael’s Hospital,Toronto,Canada;21.Interdepartmental Division of Critical Care Medicine,University of Toronto,Toronto,Canada;22.Angers,France;23.Tours,France |
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| Abstract: | PurposeUnlike 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.MethodsTwo-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.ResultsA 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.ConclusionsAerosol therapy concerns every fourth critically ill patient and one-fifth of ventilated patients. |
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