title: High-flow oxygen therapy and other inhaled therapies in intensive care units.
abstract: In this Series paper, we review the current evidence for the use of high-flow oxygen therapy, inhaled gases, and aerosols in the care of critically ill patients. The available evidence supports the use of high-flow nasal cannulae for selected patients with acute hypoxaemic respiratory failure. Heliox might prevent intubation or improve gas flow in mechanically ventilated patients with severe asthma. Additionally, it might improve the delivery of aerosolised bronchodilators in obstructive lung disease in general. Inhaled nitric oxide might improve outcomes in a subset of patients with postoperative pulmonary hypertension who had cardiac surgery; however, it has not been shown to provide long-term benefit in patients with acute respiratory distress syndrome (ARDS). Inhaled prostacyclins, similar to inhaled nitric oxide, are not recommended for routine use in patients with ARDS, but can be used to improve oxygenation in patients who are not adequately stabilised with traditional therapies. Aerosolised bronchodilators are useful in mechanically ventilated patients with asthma and chronic obstructive pulmonary disease, but are not recommended for those with ARDS. Use of aerosolised antibiotics for ventilator-associated pneumonia and ventilator-associated tracheobronchitis shows promise, but the delivered dose can be highly variable if proper attention is not paid to the delivery method.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Levy
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Jehan W
authors.initials: JW
authors.lastname: Alladina
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Hibbert
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: R Scott
authors.initials: RS
authors.lastname: Harris
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Ednan K
authors.initials: EK
authors.lastname: Bajwa
authors.affiliation: Respiratory Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: dhess@mgh.harvard.edu.
authors.forename: Dean R
authors.initials: DR
authors.lastname: Hess
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001993:Bronchodilator Agents / Q000008:administration & dosage; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D006371:Helium / Q000008:administration & dosage; D006801:Humans; D006976:Hypertension, Pulmonary / Q000628:therapy; D007362:Intensive Care Units; D008173:Lung Diseases, Obstructive / Q000628:therapy; D009569:Nitric Oxide / Q000008:administration & dosage; D010100:Oxygen / Q000008:administration & dosage; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy; D044062:Prostaglandins I / Q000008:administration & dosage; D012128:Respiratory Distress Syndrome / Q000628:therapy
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents; D044062:Prostaglandins I; D006371:Helium; D009569:Nitric Oxide; C038949:heliox; D010100:Oxygen