title: Fundamentals of aerosol therapy in critical care.
abstract: Drug dosing in critically ill patients is challenging due to the altered drug pharmacokinetics-pharmacodynamics associated with systemic therapies. For many drug therapies, there is potential to use the respiratory system as an alternative route for drug delivery. Aerosol drug delivery can provide many advantages over conventional therapy. Given that respiratory diseases are the commonest causes of critical illness, use of aerosol therapy to provide high local drug concentrations with minimal systemic side effects makes this route an attractive option. To date, limited evidence has restricted its wider application. The efficacy of aerosol drug therapy depends on drug-related factors (particle size, molecular weight), device factors, patient-related factors (airway anatomy, inhalation patterns) and mechanical ventilation-related factors (humidification, airway). This review identifies the relevant factors which require attention for optimization of aerosol drug delivery that can achieve better drug concentrations at the target sites and potentially improve clinical outcomes.
authors.affiliation: Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia. Jayesh.Dhanani@health.qld.gov.au.|Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Level 3, Ned Hanlon Building, Herston, 4029, QLD, Australia. Jayesh.Dhanani@health.qld.gov.au.
authors.forename: Jayesh
authors.identifier: 0000-0001-9803-9701
authors.initials: J
authors.lastname: Dhanani
authors.affiliation: Department of Intensive Care Medicine, The Prince Charles Hospital, Brisbane, Australia.|Critical Care Research Group, The University of Queensland, Brisbane, Australia.
authors.forename: John F
authors.initials: JF
authors.lastname: Fraser
authors.affiliation: Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Hak-Kim
authors.initials: HK
authors.lastname: Chan
authors.affiliation: Critical Care Department, Hospital Vall d'Hebron, Barcelona, Spain.|CIBERES, Vall d'Hebron Institut of Research, Barcelona, Spain.|Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.affiliation: Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.|Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Level 3, Ned Hanlon Building, Herston, 4029, QLD, Australia.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.|Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Level 3, Ned Hanlon Building, Herston, 4029, QLD, Australia.|Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia.|School of Pharmacy, The University of Queensland, Brisbane, Australia.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Roberts
mesh_terms: D000280:Administration, Inhalation; D003422:Critical Care / Q000379:methods; D016503:Drug Delivery Systems / Q000379:methods / Q000592:standards*; D004867:Equipment Design / Q000592:standards; D006371:Helium / Q000493:pharmacokinetics; D006801:Humans; D009330:Nebulizers and Vaporizers; D010100:Oxygen / Q000493:pharmacokinetics; D010316:Particle Size; D056888:Patient Positioning / Q000009:adverse effects; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods
chemical_list: D006371:Helium; C038949:heliox; D010100:Oxygen