Abstract
BackgroundAccumulated airway secretions in the endotracheal tube increase work of breathing and may favor airway colonization eventually leading to pneumonia. The aim of this preplanned substudy of the ‘Preventive Nebulization of Mucolytic Agents and Bronchodilating Drugs in Intubated and Ventilated Intensive Care Unit Patients trial’ (NEBULAE) was to compare the effect of routine vs on-demand nebulization of acetylcysteine with salbutamol on accumulation of secretions in endotracheal tubes in critically ill patients.ResultsIn this single-center substudy of a national multicenter trial, patients were randomized to a strategy of routine nebulizations of acetylcysteine with salbutamol every 6 h until end of invasive ventilation, or to a strategy with on-demand nebulizations of acetylcysteine or salbutamol applied on strict clinical indications only. The primary endpoint, the maximum reduction in cross-sectional area (CSA) of the endotracheal tube was assessed with high-resolution computed tomography. Endotracheal tubes were collected from 72 patients, 36 from patients randomized to the routine nebulization strategy and 36 of patients randomized to the on-demand nebulization strategy. The maximum cross-sectional area (CSA) of the endotracheal tube was median 12 [6 to 15]% in tubes obtained from patients in the routine nebulization group, not different from median 9 [6 to 14]% in tubes obtained from patients in the on-demand nebulization group (P = 0.33).ConclusionIn adult critically ill patients under invasive ventilation, routine nebulization of mucolytics and bronchodilators did not affect accumulation of airway secretions in the endotracheal tube.Trial registration Clinicaltrials.gov Identifier: NCT02159196
Highlights
Intensive care unit (ICU) patients frequently need invasive ventilation, which is associated with retention of airway secretions that may accumulate in the larger airways and in the endotracheal tube
In line with the hypothesis of the parent trial, it was hypothesized that a strategy of on-demand nebulizations of mucolytics or bronchodilators would not be inferior to a strategy of routine nebulizations of mucolytics with bronchodilators with respect to reduction in cross-sectional area (CSA) of the endotracheal tube
From 72 consecutive patients the endotracheal tube could be collected, from 36 patients randomized to the on-demand nebulization group and from 36 patients randomized to the routine nebulization group
Summary
Intensive care unit (ICU) patients frequently need invasive ventilation, which is associated with retention of airway secretions that may accumulate in the larger airways and in the endotracheal tube. Nebulization of mucolytic agents with bronchodilating drugs is a strategy aiming at prevention of airway obstruction in critically ill patients under invasive ventilation As it was uncertain whether such nebulizations should be applied routinely or only on strict clinical indications, the recently published ‘Preventive Nebulization of Mucolytic Agents and Bronchodilating Drugs in Intubated and Ventilated Intensive Care Unit Patients trial’ (NEBULAE) was performed. Accumulated airway secretions in the endotracheal tube increase work of breathing and may favor airway colonization eventually leading to pneumonia The aim of this preplanned substudy of the ‘Preventive Nebulization of Mucolytic Agents and Bronchodilating Drugs in Intubated and Ventilated Intensive Care Unit Patients trial’ (NEBULAE) was to compare the effect of routine vs on-demand nebulization of acetylcysteine with salbutamol on accumulation of secretions in endotracheal tubes in critically ill patients
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