title: Aerosol therapy in intensive and intermediate care units: prospective observation of 2808 critically ill patients.
abstract: OBJECTIVE
  Unlike in the outpatient setting, delivery of aerosols to critically ill patients may be considered complex, particularly in ventilated patients, and benefits remain to be proven. Many factors influence aerosol delivery and recommendations exist, but little is known about knowledge translation into clinical practice.
  
  
  METHODS
  Two-week cross-sectional study to assess the prevalence of aerosol therapy in 81 intensive and intermediate care units in 22 countries. All aerosols delivered to patients breathing spontaneously, ventilated invasively or noninvasively (NIV) were recorded, and drugs, devices, ventilator settings, circuit set-up, humidification and side effects were noted.
  
  
  RESULTS
  A total of 9714 aerosols were administered to 678 of the 2808 admitted patients (24 %, CI95 22-26 %), whereas only 271 patients (10 %) were taking inhaled medication before admission. There were large variations among centers, from 0 to 57 %. Among intubated patients 22 % (n = 262) received aerosols, and 50 % (n = 149) of patients undergoing NIV, predominantly (75 %) inbetween NIV sessions. Bronchodilators (n = 7960) and corticosteroids (n = 1233) were the most frequently delivered drugs (88 % overall), predominantly but not exclusively (49 %) administered to patients with chronic airway disease. An anti-infectious drug was aerosolized 509 times (5 % of all aerosols) for nosocomial infections. Jet-nebulizers were the most frequently used device (56 %), followed by metered dose inhalers (23 %). Only 106 (<1 %) mild side effects were observed, despite frequent suboptimal set-ups such as an external gas supply of jet nebulizers for intubated patients.
  
  
  CONCLUSIONS
  Aerosol therapy concerns every fourth critically ill patient and one-fifth of ventilated patients.
authors.affiliation: Institut National de la Santé et de la Recherche Médicale, UMR 955 and Centre National de la Recherche Scientifique, ERL 7240, Equipe de Biomécanique Cellulaire et Respiratoire, Université Paris Est, Créteil, France. stephanehrmann@gmail.com.|Réanimation Polyvalente, Centre Hospitalier Régional et Universitaire de Tours, F37044, Tours Cedex 9, France. stephanehrmann@gmail.com.|Institut National de la Santé et de la Recherche Médicale, Centre d'Étude des Pathologies Respiratoires, UMR 1100, Aérosolthérapie et Biomédicaments à Visée Respiratoire, Faculté de Medecine, Université François Rabelais, Tours, France. stephanehrmann@gmail.com.
authors.forename: Stephan
authors.identifier: http://orcid.org/0000-0001-6221-4467
authors.initials: S
authors.lastname: Ehrmann
authors.affiliation: Medicina Intensiva, Hospital Verge de la Cinta, Tortosa, Tarragona, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Roche-Campo
authors.affiliation: Réanimation Polyvalente, Centre Hospitalier Régional et Universitaire de Tours, F37044, Tours Cedex 9, France.|Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris and Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Bodet-Contentin
authors.affiliation: Assistance Publique-Hôpitaux de Paris, GHU Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Groupe de Recherche CARMAS, Créteil, France.
authors.forename: Keyvan
authors.initials: K
authors.lastname: Razazi
authors.affiliation: Intensive Care Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dugernier
authors.affiliation: Servei Medicina Intensiva, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Trenado-Alvarez
authors.affiliation: Réanimation Médicale et Médecine Hyperbare, Centre Hospitalier Régional Universitaire d'Angers, Angers, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Donzeau
authors.affiliation: Department of Intensive Care, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland.
authors.forename: François
authors.initials: F
authors.lastname: Vermeulen
authors.affiliation: Médecine Intensive Adulte et Centre des Brulés, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Thévoz
authors.affiliation: Intensive Care Unit, Hippocrateion General Hospital of Athens, Athens, Greece.
authors.forename: Metaxia
authors.initials: M
authors.lastname: Papanikolaou
authors.affiliation: Réanimation, Centre Hospitalier du Taaone, Pirae, French Polynesia.
authors.forename: Antoine
authors.initials: A
authors.lastname: Edelson
authors.affiliation: Medicina Intensiva, Hospital Nacional Edgardo Rebagliati Martins Essalud, Lima, Peru.
authors.forename: Héctor León
authors.initials: HL
authors.lastname: Yoshido
authors.affiliation: Réanimation Médicale et Médecine Hyperbare, Centre Hospitalier Régional Universitaire d'Angers, Angers, France.|Médecine Intensive Adulte et Centre des Brulés, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Lise
authors.initials: L
authors.lastname: Piquilloud
authors.affiliation: Réanimation Chirurgicale Polyvalente, Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Régional Universitaire de Nantes, F44093, Nantes, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Lakhal
authors.affiliation: UCIR-Pulmonology, Hospital de Santa Maria, CHLN, Lisbon, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Lopes
authors.affiliation: Intensive Care Unit, Hospital Lluis Alcanyis, Xativa, Valencia, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Vicent
authors.affiliation: Service de Réanimation, Centre Hospitalier d'Angoulême, Angoulême, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Desachy
authors.affiliation: Institut National de la Santé et de la Recherche Médicale, UMR 955 and Centre National de la Recherche Scientifique, ERL 7240, Equipe de Biomécanique Cellulaire et Respiratoire, Université Paris Est, Créteil, France.|Department of Dermatology, Harvard Medical School, Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, USA.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Apiou-Sbirlea
authors.affiliation: Institut National de la Santé et de la Recherche Médicale, UMR 955 and Centre National de la Recherche Scientifique, ERL 7240, Equipe de Biomécanique Cellulaire et Respiratoire, Université Paris Est, Créteil, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Isabey
authors.affiliation: Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.|Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000336:Aerosols / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D003422:Critical Care / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*
chemical_list: D000336:Aerosols; D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents
keywords: Administration, inhalation [MeSH]; Anti-bacterial agents [MeSH]; Bronchodilator agents [MeSH]; Metered dose inhalers [MeSH]; Nebulizers and vaporizers [MeSH]; Respiration, artificial [MeSH]