Arzu Ari, PhD, RRT, PT, CPFT, FAARC
Many types of aerosol devices for delivering inhaled therapeutics are available for treating mechanically ventilated patients. Each type of device has advantages and disadvantages, which are discussed in this article. Many variables must be accounted for to optimize the technique of delivery and the amount of medication administered. It begins with choosing the right device based on the medication to be administered, knowing what particle size will be produced over what period of time, then determining how aspects of mechanical ventilation will affect medication delivery and deposition. Intermittent versus continuous nebulization, the nebulizer type, the type of spacer and its electrostatic charge, and the aerosol device’s position in the ventilator circuit all affect the efficiency of aerosol delivery. Ventilator parameters, including flow rate, pressurization, and features like the presence of a heat-moisture exchanger also affect medication delivery. In addition, correct patient positioning can improve treatment efficacy and response.
Moderator: Tim Myers, RRT-NPS, MBA, FAARC
Panelists: Ariel Berlinski, MD, Bruce Rubin, MD, MEngr, MBA, Rajiv Dhand, MD, FCCP, FACP, FAARC
Many issues surround the selection and use of aerosol therapy in all populations of patients. Matching the medication to the delivery device is key, as is understanding how the mechanistic attributes of nebulizers and mechanical ventilation can work together or against each other in delivering medication effectively. Each nebulizer option offers advantages and disadvantages that need to be assessed according to patient need, the medication involved, and use with mechanical ventilation (if present). Aerosol therapy for pediatric patients poses a unique set of challenges. Standards of practice are still evolving regarding minimizing the risk ventilator-associated pneumonia with aerosol treatments. Adherence to treatment regimens is a global issue that encompasses patient perceptions, patient/family education, financial concerns, insurance reimbursement, and other factors. Our panel of experts discusses a patient-focused approach to aerosol therapy in mechanically ventilated and spontaneous breathing patients.
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10. Faculty Disclosure. Dr. Masud and Dr. Restrepo are paid consultants for Teleflex. No conflicts were disclosed for any other faculty.
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