Science and Research

Intratracheal Administration of Antimicrobial Agents in Mechanically Ventilated Adults: An International Survey on Delivery Practices and Safety

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.

  • Sole-Lleonart, C.; Rouby, J. J.; Chastre, J.; Poulakou, G.; Palmer, L. B.; Blot, S.; Felton, T.; Bassetti, M.; Luyt, C. E.; Pereira, J. M.; Riera, J.; Welte, T.; Roberts, J. A.; Rello, J.

Keywords

  • aerosol therapy
  • antibiotics
  • delivery device
  • nebulizer
Publication details
DOI: 10.4187/respcare.04519
Journal: Respiratory care
Pages: 1008-14 
Number: 8
Work Type: Original
Location: BREATH
Disease Area: PALI
Partner / Member: MHH
Access-Number: 26957647
See publication on PubMed

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