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Review
. 2021 Apr;9(7):588.
doi: 10.21037/atm-20-5665.

Aerosol delivery via invasive ventilation: a narrative review

Hui-Ling Lin  1   2   3 , James B Fink  4   5 , Huiqing Ge  6
Affiliations
Review

Aerosol delivery via invasive ventilation: a narrative review

Hui-Ling Lin et al. Ann Transl Med. 2021 Apr.

Abstract

In comparison with spontaneously breathing non-intubated subjects, intubated, mechanically ventilated patients encounter various challenges, barriers, and opportunities in receiving medical aerosols. Since the introduction of mechanical ventilation as a part of modern critical care medicine during the middle of the last century, aerosolized drug delivery by jet nebulizers has become a common practice. However, early evidence suggested that aerosol generators differed in their efficacies, and the introduction of newer aerosol technology (metered dose inhalers, ultrasonic nebulizer, vibrating mesh nebulizers, and soft moist inhaler) into the ventilator circuit opened up the possibility of optimizing inhaled aerosol delivery during mechanical ventilation that could meet or exceed the delivery of the same aerosols in spontaneously breathing patients. This narrative review will catalogue the primary variables associated with this process and provide evidence to guide optimal aerosol delivery and dosing during mechanical ventilation. While gaps exist in relation to the appropriate aerosol drug dose, discrepancies in practice, and cost-effectiveness of the administered aerosol drugs, we also present areas for future research and practice. Clinical practice should expand to incorporate these techniques to improve the consistency of drug delivery and provide safer and more effective care for patients.

Keywords: Invasive mechanical ventilation; aerosol therapy; inhaled drugs; lung deposition.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-5665). The series “Medical Aerosol in Acute and Critical Care” was commissioned by the editorial office without any funding or sponsorship. JBF served as the unpaid Guest Editor of the series and is Chief Science Officer for Aerogen Pharma Corp. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Particle deposition pattern during invasive ventilation. From Ref. (12) with permission.
Figure 2
Figure 2
Comparisons of soft moist inhaler with a commercial adaptor actuated at expiratory phase generated the highest delivered dose with a commercial adaptor. From Ref. (35) with permission.
Figure 3
Figure 3
Study experimental scheme of the study on HFVO. Both nebulizers delivery greater drug dose placing at proximal to the endotracheal tube, and a VMN delivers greater drug dose then a JN. From Ref. (58) with permission.
Figure 4
Figure 4
Comparison of inhaled drug mass among 3 modes of nebulization and the experimental set up. Inhaled drug dose was similar across three nebulization modes. From Ref. (16) with permission.
See this image and copyright information in PMC

References

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