Key considerations on nebulization of antimicrobial agents to mechanically ventilated patients.
Identifieur interne : 000913 ( Main/Exploration ); précédent : 000912; suivant : 000914Key considerations on nebulization of antimicrobial agents to mechanically ventilated patients.
Auteurs : J. Rello [Espagne] ; J J Rouby [France] ; C. Sole-Lleonart [Suisse] ; J. Chastre [France] ; S. Blot [Belgique] ; C E Luyt [France] ; J. Riera [Espagne] ; M C Vos [Pays-Bas] ; A. Monsel [France] ; J. Dhanani [Australie] ; J A Roberts [Australie]Source :
- Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases [ 1469-0691 ] ; 2017.
Abstract
Nebulized antibiotics have an established role in patients with cystic fibrosis or bronchiectasis. Their potential benefit to treat respiratory infections in mechanically ventilated patients is receiving increasing interest. In this consensus statement of the European Society of Clinical Microbiology and Infectious Diseases, the body of evidence of the therapeutic utility of aerosolized antibiotics in mechanically ventilated patients was reviewed and resulted in the following recommendations: Vibrating-mesh nebulizers should be preferred to jet or ultrasonic nebulizers. To decrease turbulence and limit circuit and tracheobronchial deposition, we recommend: (a) the use of specifically designed respiratory circuits avoiding sharp angles and characterized by smooth inner surfaces, (b) the use of specific ventilator settings during nebulization including use of a volume controlled mode using constant inspiratory flow, tidal volume 8 mL/kg, respiratory frequency 12 to 15 bpm, inspiratory:expiratory ratio 50%, inspiratory pause 20% and positive end-expiratory pressure 5 to 10 cm H2O and (c) the administration of a short-acting sedative agent if coordination between the patient and the ventilator is not obtained, to avoid patient's flow triggering and episodes of peak decelerating inspiratory flow. A filter should be inserted on the expiratory limb to protect the ventilator flow device and changed between each nebulization to avoid expiratory flow obstruction. A heat and moisture exchanger and/or conventional heated humidifier should be stopped during the nebulization period to avoid a massive loss of aerosolized particles through trapping and condensation. If these technical requirements are not followed, there is a high risk of treatment failure and adverse events in mechanically ventilated patients receiving nebulized antibiotics for pneumonia.
DOI: 10.1016/j.cmi.2017.03.018
PubMed: 28347790
Affiliations:
- Australie, Belgique, Espagne, France, Pays-Bas, Suisse
- Canton de Vaud, Catalogne, Hollande-Méridionale, Province de Flandre-Orientale, Région flamande, Île-de-France
- Barcelone, Gand, Lausanne, Paris, Rotterdam
- Université Pierre-et-Marie-Curie, Université de Gand
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Rello</name><affiliation wicri:level="3"><nlm:affiliation>European Study Group for Infections in Critically Ill Patients (ESGCIP), Barcelona, Spain. Electronic address: jrello@crips.es.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>European Study Group for Infections in Critically Ill Patients (ESGCIP), Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Rouby, J J" sort="Rouby, J J" uniqKey="Rouby J" first="J J" last="Rouby">J J Rouby</name><affiliation wicri:level="3"><nlm:affiliation>Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière hospital, Assistance Publique Hôpitaux de Paris, University Pierre et Marie Curie (UPMC) of Paris 6, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière hospital, Assistance Publique Hôpitaux de Paris, University Pierre et Marie Curie (UPMC) of Paris 6, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Sole Lleonart, C" sort="Sole Lleonart, C" uniqKey="Sole Lleonart C" first="C" last="Sole-Lleonart">C. Sole-Lleonart</name><affiliation wicri:level="3"><nlm:affiliation>Critical Care Department, CHUV, Lausanne, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Critical Care Department, CHUV, Lausanne</wicri:regionArea><placeName><settlement type="city">Lausanne</settlement><region nuts="3" type="region">Canton de Vaud</region></placeName></affiliation></author><author><name sortKey="Chastre, J" sort="Chastre, J" uniqKey="Chastre J" first="J" last="Chastre">J. Chastre</name><affiliation wicri:level="4"><nlm:affiliation>Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie (UPMC) of Paris 6, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie (UPMC) of Paris 6, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement><settlement type="city">Paris</settlement></placeName><orgName type="university">Université Pierre-et-Marie-Curie</orgName></affiliation></author><author><name sortKey="Blot, S" sort="Blot, S" uniqKey="Blot S" first="S" last="Blot">S. Blot</name><affiliation wicri:level="4"><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, European Study Group for Infections in Critically Ill Patients (ESGCIP), Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, European Study Group for Infections in Critically Ill Patients (ESGCIP), Ghent</wicri:regionArea><orgName type="university">Université de Gand</orgName><placeName><settlement type="city">Gand</settlement><region>Région flamande</region><region type="district" nuts="2">Province de Flandre-Orientale</region></placeName></affiliation></author><author><name sortKey="Luyt, C E" sort="Luyt, C E" uniqKey="Luyt C" first="C E" last="Luyt">C E Luyt</name><affiliation wicri:level="4"><nlm:affiliation>Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie (UPMC) of Paris 6, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie (UPMC) of Paris 6, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement><settlement type="city">Paris</settlement></placeName><orgName type="university">Université Pierre-et-Marie-Curie</orgName></affiliation></author><author><name sortKey="Riera, J" sort="Riera, J" uniqKey="Riera J" first="J" last="Riera">J. Riera</name><affiliation wicri:level="3"><nlm:affiliation>Critical Care Department, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Vall d'Hebron Institut of Research, Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Critical Care Department, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Vall d'Hebron Institut of Research, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Vos, M C" sort="Vos, M C" uniqKey="Vos M" first="M C" last="Vos">M C Vos</name><affiliation wicri:level="3"><nlm:affiliation>Department of Medical Microbiology and Infectious Diseases, European Study Group of Nosocomial Infections (ESGNI), Rotterdam, The Netherlands.</nlm:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Medical Microbiology and Infectious Diseases, European Study Group of Nosocomial Infections (ESGNI), Rotterdam</wicri:regionArea><placeName><settlement type="city">Rotterdam</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Monsel, A" sort="Monsel, A" uniqKey="Monsel A" first="A" last="Monsel">A. Monsel</name><affiliation wicri:level="3"><nlm:affiliation>Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière hospital, Assistance Publique Hôpitaux de Paris, University Pierre et Marie Curie (UPMC) of Paris 6, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière hospital, Assistance Publique Hôpitaux de Paris, University Pierre et Marie Curie (UPMC) of Paris 6, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Dhanani, J" sort="Dhanani, J" uniqKey="Dhanani J" first="J" last="Dhanani">J. Dhanani</name><affiliation wicri:level="1"><nlm:affiliation>Burns Trauma and Critical Care Research Centre and Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Brisbane, Australia.</nlm:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Burns Trauma and Critical Care Research Centre and Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Brisbane</wicri:regionArea><wicri:noRegion>Brisbane</wicri:noRegion></affiliation></author><author><name sortKey="Roberts, J A" sort="Roberts, J A" uniqKey="Roberts J" first="J A" last="Roberts">J A Roberts</name><affiliation wicri:level="1"><nlm:affiliation>Burns Trauma and Critical Care Research Centre and Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Brisbane, Australia.</nlm:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Burns Trauma and Critical Care Research Centre and Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Brisbane</wicri:regionArea><wicri:noRegion>Brisbane</wicri:noRegion></affiliation></author></analytic><series><title level="j">Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases</title><idno type="eISSN">1469-0691</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Nebulized antibiotics have an established role in patients with cystic fibrosis or bronchiectasis. Their potential benefit to treat respiratory infections in mechanically ventilated patients is receiving increasing interest. In this consensus statement of the European Society of Clinical Microbiology and Infectious Diseases, the body of evidence of the therapeutic utility of aerosolized antibiotics in mechanically ventilated patients was reviewed and resulted in the following recommendations: Vibrating-mesh nebulizers should be preferred to jet or ultrasonic nebulizers. To decrease turbulence and limit circuit and tracheobronchial deposition, we recommend: (a) the use of specifically designed respiratory circuits avoiding sharp angles and characterized by smooth inner surfaces, (b) the use of specific ventilator settings during nebulization including use of a volume controlled mode using constant inspiratory flow, tidal volume 8 mL/kg, respiratory frequency 12 to 15 bpm, inspiratory:expiratory ratio 50%, inspiratory pause 20% and positive end-expiratory pressure 5 to 10 cm H2O and (c) the administration of a short-acting sedative agent if coordination between the patient and the ventilator is not obtained, to avoid patient's flow triggering and episodes of peak decelerating inspiratory flow. A filter should be inserted on the expiratory limb to protect the ventilator flow device and changed between each nebulization to avoid expiratory flow obstruction. A heat and moisture exchanger and/or conventional heated humidifier should be stopped during the nebulization period to avoid a massive loss of aerosolized particles through trapping and condensation. If these technical requirements are not followed, there is a high risk of treatment failure and adverse events in mechanically ventilated patients receiving nebulized antibiotics for pneumonia.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Belgique</li><li>Espagne</li><li>France</li><li>Pays-Bas</li><li>Suisse</li></country><region><li>Canton de Vaud</li><li>Catalogne</li><li>Hollande-Méridionale</li><li>Province de Flandre-Orientale</li><li>Région flamande</li><li>Île-de-France</li></region><settlement><li>Barcelone</li><li>Gand</li><li>Lausanne</li><li>Paris</li><li>Rotterdam</li></settlement><orgName><li>Université Pierre-et-Marie-Curie</li><li>Université de Gand</li></orgName></list><tree><country name="Espagne"><region name="Catalogne"><name sortKey="Rello, J" sort="Rello, J" uniqKey="Rello J" first="J" last="Rello">J. Rello</name></region><name sortKey="Riera, J" sort="Riera, J" uniqKey="Riera J" first="J" last="Riera">J. Riera</name></country><country name="France"><region name="Île-de-France"><name sortKey="Rouby, J J" sort="Rouby, J J" uniqKey="Rouby J" first="J J" last="Rouby">J J Rouby</name></region><name sortKey="Chastre, J" sort="Chastre, J" uniqKey="Chastre J" first="J" last="Chastre">J. Chastre</name><name sortKey="Luyt, C E" sort="Luyt, C E" uniqKey="Luyt C" first="C E" last="Luyt">C E Luyt</name><name sortKey="Monsel, A" sort="Monsel, A" uniqKey="Monsel A" first="A" last="Monsel">A. Monsel</name></country><country name="Suisse"><region name="Canton de Vaud"><name sortKey="Sole Lleonart, C" sort="Sole Lleonart, C" uniqKey="Sole Lleonart C" first="C" last="Sole-Lleonart">C. Sole-Lleonart</name></region></country><country name="Belgique"><region name="Région flamande"><name sortKey="Blot, S" sort="Blot, S" uniqKey="Blot S" first="S" last="Blot">S. Blot</name></region></country><country name="Pays-Bas"><region name="Hollande-Méridionale"><name sortKey="Vos, M C" sort="Vos, M C" uniqKey="Vos M" first="M C" last="Vos">M C Vos</name></region></country><country name="Australie"><noRegion><name sortKey="Dhanani, J" sort="Dhanani, J" uniqKey="Dhanani J" first="J" last="Dhanani">J. Dhanani</name></noRegion><name sortKey="Roberts, J A" sort="Roberts, J A" uniqKey="Roberts J" first="J A" last="Roberts">J A Roberts</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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