Aerosolized drug delivery during mechanical ventilation

Abstract

Mechanical ventilation was historically considered as a barrier to administer inhaled aerosolized drugs. Nowadays, inhaled aerosolized drug administration during mechanical ventilation is quite relevant, thanks to the understanding of the key factors ruling the complex interaction between the aerosol and mechanical ventilation. Availability of beta-2-mimetics and corticosteroids as metered-dose inhalers makes their delivery simple when using inhalation chambers dedicated to mechanical ventilation. Administration of other molecules like antibiotics requires the use of a nebulizer. The choice between pneumatic, ultra-sonic, and mesh nebulizers will be discussed. Several means allow optimizing nebulization performance, including the placement of continuous nebulizer 15–40 cm before the Y piece, the reduction in inspiratory flow, and the use of inspiration-synchronized nebulizers. When performed during mechanical ventilation, they led to significant clinical results. Here, experimental and clinical data regarding beta-2-agonists, corticosteroids, and antibiotics efficiency when delivered as inhaled aerosols during mechanical ventilation, will be high-lightened. Consistently, inhaled treatment of ventilator associated pneumonia appears promising. Finally, recommendations for implementation of aerosol therapy during mechanical ventilation will be presented for the clinical practice.