Chapter 10 - Clinical Application of Aerosols in Hospitalized Patients
Chapter 10.1 Aerosol Therapy in the Emergency Department by Alexander G. Duarte, MD and Rajiv Dhand, MD
Asthma and chronic obstructive pulmonary disease are prevalent conditions associated with sudden, symptomatic decline in respiratory function requiring urgent treatment. Management of acute airflow obstruction includes frequent, thorough assessments as well as timely administration of supplemental oxygen, corticosteroids and inhalational drug delivery of short- acting bronchodilators. The benefits of inhaled administration of aerosolized short-acting bronchodilators include rapid symptom relief and improvements in lung function with fewer side effects. To optimize these benefits requires an understanding of the factors concerning aerosol delivery in the acute care setting that include patient age, severity of airway obstruction, aerosol generating device and the patient and device interface.
Chapter 10.2 Aerosol Therapy During Noninvasive Ventilation by Dean R. Hess, PhD, RRT
Noninvasive ventilation (NIV) is being used increasingly in patients with acute respiratory failure. The most commonly used interfaces for NIV are oronasal or nasal masks, but other interfaces are also used. Critical care ventilators, bilevel ventilators designed specifically for NIV, and intermediate ventilators can be used. There are three options for aerosol delivery during NIV. The patient can be removed from NIV and the aerosol administered by nebulizer or pressurized metered-dose inhaler (pMDI) in the usual manner, a nebulizer placed in-line, or a spacer chamber with metered-dose inhaler in-line. The available evidence suggests that a nebulizer or pMDI can administer a significant amount of bronchodilator during NIV.
Chapter 10.3 Aerosol Therapy in Mechanically Ventilated Patients
James B. Fink, PhD, RRT and Arzu Ari, PhD
Inhaled medications are an essential component of the treatment of ventilator-dependent patients with pulmonary disorders. However, effective aerosol delivery of drugs to mechanically ventilated patients poses substantial challenges in critical pulmonary care. There are many issues with selection and use of aerosol devices in patients receiving ventilator support. This chapter reviews aerosol devices used during mechanical ventilation and explains implications for aerosol administration in different artificial airways and modes of ventilation. Optimum techniques of aerosol administration with various devices and factors affecting aerosol delivery to ventilator- dependent patients are also discussed.
Chapter 10.4 Aerosolized Antibiotics for Ventilator–associated Infections
by Lucy B. Palmer, MD
With the rapid rise in multi-drug resistant organisms in much of the world, effective treatment for ventilator-associated infections with current systemic antibiotics is increasingly challenging in critically ill patients. Aerosolized antibiotics provide high concentrations of drug in the lung that could not be achieved with intravenous antibiotics without significant systemic toxicity. This review summarizes current evidence describing the use of aerosolized antimicrobial therapy
for the treatment of bacterial ventilator-associated infections. Inhaled adjunctive therapy has been described in numerous small non-randomized studies and in four recent randomized placebo-controlled trials. Aerosolized therapy has also been used to treat ventilator-associated tracheobronchitis. These preliminary data suggest aerosolized delivery of antimicrobials may effectively treat resistant pathogens.
