Lyu Shan, Li Jie, Yang Limin, Du Xiaoliang, Liu Xiaoyi, Chuan Libo, Jing Guoqiang, Wang Zhenyan, Shu Weiwei, Ye Chunjuan, Dong Qionglan, Duan Jun, Fink James B, Gao Zhancheng, Liang Zongan
Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China.
Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, IL, USA.
Ann Transl Med. 2020 Sep;8(17):1071. doi: 10.21037/atm-20-1313.
Aerosol delivery via mechanical ventilation has been reported to vary significantly among different intensive care units (ICU). The optimal technique for using each aerosol generator may need to be updated with the available evidence.
A 2-week prospective multicenter observational cohort study was implemented to record aerosol delivery for mechanically ventilated adult patients in Chinese ICUs. Our data included the type of aerosol device and its placement, ventilator type, humidification, and aerosolized medication administered. A guide for the optimal technique for aerosol delivery during mechanical ventilation was summarized after a thorough literature review.
A total of 160 patients (105 males) from 28 ICUs were enrolled, of whom 125 (78.1%) received aerosol therapy via invasive ventilation. Among these 125 patients, 53 received ventilator-integrated jet nebulizer, with 64% (34/53) of them placed the nebulizer close to Y piece in the inspiratory limb. Further, 56 patients used continuous nebulizers, with 84% (47/56) of them placed the nebulizer close to the Y piece in the inspiratory limb. Of the 35 patients who received aerosol therapy via noninvasive ventilation, 30 received single limb ventilators and continuous nebulizers, with 70% (21/30) of them placed between the mask and exhalation port. Only 36% (58/160) of the patients received aerosol treatments consistent with optimal practice.
Aerosol delivery via mechanical ventilation varied between ICUs, and only 36% of the patients received aerosol treatments consistent with optimal practice. ICU clinicians should be educated on the best practices for aerosol therapy, and quality improvement projects aim to improve the quality and outcome of patients with the optimal technique for aerosol delivery during mechanical ventilation are warranted.
据报道，不同重症监护病房（ICU）通过机械通气进行的气溶胶给药差异显著。每种气溶胶发生器的最佳使用技术可能需要根据现有证据进行更新。
开展了一项为期2周的前瞻性多中心观察性队列研究，以记录中国ICU中接受机械通气的成年患者的气溶胶给药情况。我们的数据包括气溶胶装置的类型及其放置位置、呼吸机类型、加湿情况以及所给予的雾化药物。在全面的文献综述后，总结了机械通气期间气溶胶给药的最佳技术指南。
来自28个ICU的160例患者（105例男性）入组，其中125例（78.1%）通过有创通气接受气溶胶治疗。在这125例患者中，53例使用呼吸机集成喷射雾化器，其中64%（34/53）将雾化器放置在吸气支靠近Y形接头处。此外，56例患者使用持续雾化器，其中84%（47/56）将雾化器放置在吸气支靠近Y形接头处。在35例通过无创通气接受气溶胶治疗的患者中，30例使用单肢呼吸机和持续雾化器，其中70%（21/30）将其放置在面罩和呼气口之间。只有36%（58/160）的患者接受了符合最佳实践的气溶胶治疗。
不同ICU之间通过机械通气进行的气溶胶给药存在差异，只有36%的患者接受了符合最佳实践的气溶胶治疗。应向ICU临床医生传授气溶胶治疗的最佳实践，并且有必要开展质量改进项目，以采用机械通气期间气溶胶给药的最佳技术来提高患者的治疗质量和预后。
