title: Intratracheal Administration of Antimicrobial Agents in Mechanically Ventilated Adults: An International Survey on Delivery Practices and Safety.
abstract: BACKGROUND
  Intratracheal antibiotic administration is increasingly used for treating respiratory infections. Limited information is available on delivery devices, techniques, and safety.
  
  
  METHODS
  An online survey on intratracheal administration of anti-infective agents in mechanically ventilated adults was answered by health-care workers from 192 ICUs to assess the most commonly used devices, current delivery practices, and safety issues. We investigated whether ICU usage experience (≥3 y) impacted its performance.
  
  
  RESULTS
  Intratracheal antibiotic administration was a current practice in 87 ICUs (45.3%), with 40 (46%) having experience with the technique (≥3 y). Sixty-six (78.6%) of 84 health-care workers reported avoiding intratracheal antibiotic administration due to an absence of evidence-based guidelines (78.6%). Jet nebulizers were the most commonly used devices for delivery, in 24 less experienced ICUs (27.6%) and in 18 (20.7%) experienced ICUs. Direct tracheal instillation (6; 6.9%) was still considered for drug prescription in 12 ICUs (6.9%). More experience resulted in neither greater adherence to measures improving the drug's delivery efficiency (93 measures in the experienced group; 27.9%) nor a greater adoption of measures to increase safety. Indeed, the expiratory filter was changed after each nebulization in only 2 experienced ICUs (6.9%), whereas 15 (51.7%) changed it daily instead.
  
  
  CONCLUSIONS
  Intratracheal antibiotic administration is a common therapeutic modality in ICUs, but inadequate practices were widely encountered, independent of the level of experience with the technique. This suggests a need to develop standardization to reduce variability and improve safety and efficacy.
authors.affiliation: University of Toronto, UHN & Mount Sinai Hospital, Toronto, Canada and Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Candela
authors.initials: C
authors.lastname: Solé-Lleonart
authors.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.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Rouby
authors.affiliation: Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie of Paris, Paris, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
authors.affiliation: 4th Department of Internal Medicine, Athens University School of Medicine, Attikon University General Hospital, Athens, Greece.
authors.forename: Garyfallia
authors.initials: G
authors.lastname: Poulakou
authors.affiliation: Pulmonary, Critical Care, and Sleep Division, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York.
authors.forename: Lucy B
authors.initials: LB
authors.lastname: Palmer
authors.affiliation: Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium.
authors.forename: Stijn
authors.initials: S
authors.lastname: Blot
authors.affiliation: Acute Intensive Care Unit, University Hospital of South Manchester, Manchester, United Kingdom.
authors.forename: Tim
authors.initials: T
authors.lastname: Felton
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bassetti
authors.affiliation: Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie of Paris, Paris, France.
authors.forename: Charles-Eduard
authors.initials: CE
authors.lastname: Luyt
authors.affiliation: Emergency and Intensive Care Department, Centro Hospitalar S João EPE, University of Porto, Porto, Portugal.
authors.forename: Joao Manuel
authors.initials: JM
authors.lastname: Pereira
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, Centro Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Vall d'Hebron Institute of Research, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Riera
authors.affiliation: Department of Pulmonary Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.affiliation: Burns Trauma and Critical Care Research Centre, University of Queensland, Butterfield Street, Herston, Brisbane, Australia.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Roberts
authors.affiliation: Vall d'Hebron University Hospital, CIBERES, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain. jrello@crips.es.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D016503:Drug Delivery Systems / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data*; D007442:Intubation, Intratracheal / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D008297:Male; D009330:Nebulizers and Vaporizers / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000592:standards / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
chemical_list: D000890:Anti-Infective Agents
keywords: aerosol therapy; antibiotics; delivery device; nebulizer