Topical drug delivery to the ventilated patient

Mechanical ventilation, whether invasive or non-invasive, may compromise the delivery of bronchodilator aerosols. The amount of nebulised drug reaching the airways depends on the nebuliser design, driving gas flow, characteristics of the ventilator tubing, and the size of the endotracheal tube.47 71 Drug delivery may vary from 0% to 42% in ventilated patients.72 The presence of humidification alone may reduce drug deposition by as much as 40%, but may be reversed by the addition of a spacer device.73 74 Both ultrasonic and jet nebulis-ers are effective in ventilated patients.75 Nebulisers may, however, be a source of bacterial contamination.76

Metered dose inhalers have been widely used and may provide at least as good drug delivery as nebulisers, depending on actuator design and the presence of humidification and spacer devices.77 78 The recommended characteristics of aerosol delivery systems used in ventilated patients are shown in box 13.4. Ideally, each aerosol delivery system should be evaluated for each type of ventilator circuit used.73

Coping with Asthma

Coping with Asthma

If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

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