A Scandinavian survey of drug administration through inhalation, suctioning and recruitment maneuvers in mechanically ventilated patients.
BACKGROUND
The aim was to describe current practices for drug administration through inhalation, endotracheal suctioning and lung recruitment maneuvers in mechanically ventilated patients in Scandinavian intensive care units (ICUs).


METHODS
We invited 161 ICUs to participate in a web-based survey regarding (1) their routine standards and (2) current treatment of ventilated patients during the past 24 h. In order to characterize the patients, the lowest PaO(2) with the corresponding highest FiO(2), and the highest PaO(2) with the corresponding lowest FiO(2) during the 24-h study period were recorded.


RESULTS
Eighty-seven ICUs answered and reported 186 patients. Positive end-expiratory pressure (PEEP) levels (cmH(2)O) were 5-9 in 65% and >10 in 31% of the patients. Forty percent of the patients had heated humidification and 50% received inhalation of drugs. Endotracheal suctioning was performed >7 times during the study period in 40% of the patients, of which 23% had closed suction systems. Twenty percent of the patients underwent recruitment maneuvers. The most common recruitment maneuver was to increase PEEP and gradually increase the inspiratory pressure. Twenty-six percent of the calculated PaO(2)/FiO(2) ratios varied >13 kPa for the same patient.


CONCLUSIONS
Frequent use of drug administration through inhalation and endotracheal suctioning predispose to derecruitment of the lungs, possibly resulting in the large variations in PaO(2)/FiO(2) ratios observed during the 24-h study period. Recruitment maneuvers were performed only in one-fifth of the patients during the day of the survey.
Grivans
C
C
Department of Anaesthesia and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. christina.grivans@vgregion.se
Lindgren
S
S
Aneman
A
A
Stenqvist
O
O
Lundin
S
S
D000280:Administration, Inhalation; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D006813:Humidity; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008168:Lung / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D011175:Positive-Pressure Respiration; D016684:Prone Position; D012121:Respiration, Artificial; D012537:Scandinavian and Nordic Countries; D013396:Suction; D014132:Trachea / Q000502:physiology
D004364:Pharmaceutical Preparations