Aerosolized Research Articles

Aerosolized plus intravenous colistin vs intravenous colistin alone for the treatment of nosocomial pneumonia due to multidrug-resistant Gram-negative bacteria: A retrospective cohort study

ObjectiveTo compare the effectiveness and safety of aerosolized (AER) plus intravenous (IV) colistin with IV colistin alone in patients with nosocomial pneumonia (NP) due to multidrug-resistant (MDR) Gram-negative bacteria. MethodsThis was a retrospective cohort study of adults with NP who received IV colistin alone or in combination with AER colistin. The primary endpoint was clinical cure at end of therapy. Secondary endpoints included microbiological eradication, in-hospital mortality and nephrotoxicity. ResultsIn total, 135 patients were included in this study: 65 patients received AER plus IV colistin and 70 patients received IV colistin alone. Baseline characteristics were similar between the two groups. Clinical cure was achieved in 42 (65%) patients who received AER plus IV colistin and 26 (37%) patients who received IV colistin alone (P = 0.01). Among a total of 88 patients who were microbiologically evaluable, 27 (42%) patients who received AER plus IV colistin and 12 (17%) patients who received IV colistin alone attained favourable microbiological outcomes (P = 0.022). In-hospital mortality (43% vs 59%, P = 0.072) was higher in patients who received IV colistin alone, but the difference was not significant. Renal injury occurred in 31% of patients who received AER plus IV colistin and in 41% of patients who received IV colistin alone (P = 0.198). ConclusionAER colistin can be considered as salvage therapy as an adjunct to IV administration for the treatment of patients with NP due to MDR Gram-negative pathogens.

Aerosol drug delivery to tracheotomized patients with COVID-19: Pragmatic suggestions for clinicians.

Because of the wide and rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the number of hospitalized patients with coronavirus disease 2019 (COVID-19) has rapidly increased medically complex and resource-intensive treatment requirements in health care settings. Although tracheostomy is frequently needed for critically ill patients requiring extended mechanical ventilation, it has been described as an aerosol-generating procedure that puts health care professionals at an increased risk of viral transmission. In addition, the delivery of aerosolized medications to this patient population has become controversial because of concerns on the transmission of SARS-CoV-2 via droplets. Although aerosol therapy in spontaneously breathing patients with COVID-19 was described in recent publications, innovations in aerosol drug delivery to COVID-19 patients with tracheostomy have not been presented. Therefore, empirically based guidance on how to deliver aerosols safely and effectively to tracheotomized patients with COVID-19 is still lacking. This paper provides recommendations and rationales for device selection, interface selection, delivery techniques, and infection control based on the evolving body of literature.

Elektivna odprta traheotomija pri bolniku s covidom-19

Traheotomija in postopki, povezani z njo pri bolniku s covidom-19, se ocenjujejo kot visoko tvegani za prenos virusa SARS-CoV-2 na ekipo, ki poseg opravlja, in osebje, ki po operaciji skrbi za bolnika. Namen članka je prikazati prilagoditev postopkov elektivne odprte kirurške traheotomije pri dolgotrajno intubiranih bolnikih zaradi okužbe z virusom SARS-CoV-2. Pripravljen je bil osnovni protokol za elektivno odprto kirurško traheotomijo pri bolnikih s covidom-19, ki se začne pri multidisciplinarni postavitvi indikacije za traheotomijo za vsakega bolnika posebej. Za razliko od običajnih okoliščin se traheotomija pri bolniku s covidom-19 izvede kasneje, in sicer v sobi intenzivne enote in ob uporabi ustrezne osebne varovalne opreme. Svetuje se vzpostavitev tima za covid-19, sestavljenega iz izkušenega osebja, ki operacijo izvede varno, hitro in zanesljivo. Opisujemo kirurško izvedbo traheotomije, pri kateri je bistvenega pomena, prvič, usklajeno in specifično sodelovanje kirurške in anesteziološke ekipe po prej dogovorjenem postopku, in, drugič, odsotnost in izogibanje uporabi pripomočkov in postopkov, ki sprožajo nastanek aerosola. Pod podobnimi pogoji se nato opravljata tudi skrb za bolnika po operaciji in reševanje morebitnih zapletov po njej. Pomembno je, da je mešiček pri bolniku s covidom-19 stalno napihnjen in da se trahealna kanila menja čim manjkrat in čim kasneje.

214: A Multidisciplinary Team Using a Modified Percutaneous Surgical Tracheostomy for COVID-19 Patients

Tompeck, Allison1; Keric, Natasha1; Crigger, Morgan2; Bosarge, Patrick1 Author Information

A Super-Spreader Outbreak of Andean Hantavirus

Hantavirus pulmonary syndrome is a zoonosis with a high fatality rate. Infection usually occurs by inhalation of aerosolized rodent secreta or excreta;

TRACHEOSTOMY AND COVID-19 ARDS: ONE ACADEMIC CENTER’S EXPERIENCE

TRACHEOSTOMY AND COVID-19 ARDS: ONE ACADEMIC CENTER’S EXPERIENCE

Intravenous vs intravenous plus aerosolized colistin for treatment of ventilator-associated pneumonia – a matched case–control study in neonates

ABSTRACT Background Recently intravenous (IV) and aerosolized (ASZ) colistin have been used for treating ventilator-associated pneumonia (VAP) due to colistin susceptible multidrug-resistant Gram-negative bacteria (MDR-GNB). Colistin has limited lung penetration. We compared the efficacy and safety of IV-alone versus IV+ASZ-colistin for treating VAP in neonates. Methods This retrospective matched case–control study was performed at NICU of the Aga Khan University Hospital, Pakistan between January 2015 and December 2018. Sixteen neonates with MDR-GNB associated VAP received IV-ASZ-colistin and were matched for date of birth, gestational age, birth weight, Apgar score, antenatal steroid history, disease severity, and duration of mechanical ventilation with 16 control neonates who received IV-colistin alone. Results Both groups had similar MDR-GNB isolates and Acinetobacter baumannii (78%) was the most common pathogen. No colistin-resistant strain was isolated. Duration of IV-colistin and concomitant antibiotics use was significantly (p < 0.05) shorter in the IV-ASZ-colistin group. Significantly (p < 0.05) higher clinical cure and microbial eradication, along with lower ventilatory requirements, mortality rate, and colistin induced nephrotoxicity and electrolyte imbalance was observed in the IV-ASZ-colistin group. Conclusions With better lung penetration, ASZ-colistin offers effective and safe microbiological and clinical benefits as adjunctive or alternate treatment of VAP due to colistin susceptible MDR-GNB in neonates.

Mouthrinses to reduce aerosolized microorganisms

Mouthrinses to reduce aerosolized microorganisms

Solving the problems of gas leakage at laparoscopy.

Gas leakage during minimally invasive surgery is an aerosolization hazard. Sensitive optical and thermographic imaging can demonstrate and differentiate between mechanistic categories, enabling engineering solutions to fortify surgical care against pollutants and pathogens affecting operating room teams. Areas for improvement.

Mouthrinses to reduce aerosolized microorganisms

Mouthrinses to reduce aerosolized microorganisms

Perioperative Implications of Vaping

Over the past 10 - 15 years, there has been a significant increase in the use of electronic cigarettes. These devices are generally used to deliver nicotine through inhalation by aerosolization. While the long-term risk of lung cancer is yet to be known, the chemicals and impurities in the solutions may have other acute and chronic effects on the respiratory system including respiratory failure from adult respiratory distress syndrome. Recent concerns have been raised regarding the potential for significant acute and chronic health care risks of these devices including pneumonitis, airway reactivity and respiratory failure. Given that many of the acute effects are related to the respiratory system, anesthetic care may be required during diagnostic procedures including bronchoscopy to investigate the etiology of acute respiratory symptomatology. We present an adolescent who presented to the operating room for bronchoscopy and bronchoalveolar lavage to investigate the etiology of respiratory involvement following an episode of vaping. The healthcare and end-organ effects of nicotine, tobacco smoke and vaping are discussed, and potential anesthetic implications are presented. J Med Cases. 2020;11(5):129-134 doi: https://doi.org/10.14740/jmc3451

Effect of inhaled aerosolized budesonide and salbutamol on HIF-1α/VEGF signaling pathway in collapsed lung tissues of rabbits undergoing one-lung ventilation

Objective To evaluate the effect of inhaled aerosolized budesonide and salbutamol on hypoxia-inducible factor-1α (HIF-1α)/vascular endothelial growth factor (VEGF) signaling pathway in collapsed lung tissues of rabbits undergoing one-lung ventilation (OLV). Methods Twenty-four healthy male New Zealand white rabbits, aged 5-6 months, weighing 2.5-3.0 kg, were randomized into 3 groups (n=8 each) using a random number table method: two-lung ventilation (TLV) group, OLV group, and budesonide and salbutamol aerosol inhalation group (group B+ S). Bilateral lungs were ventilated for 3 h in group TLV, and the left lung was ventilated for 2 h followed by 1-h TLV in group OLV and B+ S group.In group B+ S, aerosolized salbutamol 0.15 mg/kg and budesonide 1 mg in normal saline (2 ml in total) was inhaled before OLV.The equal volume of normal saline was given instead in TLV and OLV groups.Volume-controlled ventilation was used in each group.Before beginning of aerosol inhalation (T0), immediately after the end of aerosol inhalation (T1), and at 1, 2 and 3 h of ventilation (T2-4), arterial blood samples were obtained for blood gas analysis.Oxygenation index was calculated.The rabbits were sacrificed at the end of ventilation, and lower lobe tissues were obtained from the collapsed lung for examination of the pathological changes (with a light microscope) which were scored and for determination of HIF-1α and VEGF expression in lung tissues (by Western blot). Results Compared with group TLV, oxygenation index was significantly decreased at T2-4, the concentration of lactic acid and lung injury score were increased, and the expression of HIF-1α and VEGF was up-regulated in group OLV and group B+ S (P<0.05). Compared with group OLV, oxygenation index was significantly increased at T2-4, the concentration of lactic acid and lung injury score were decreased, and the expression of HIF-1α and VEGF was down-regulated in group S+ B (P<0.05). Conclusion The mechanism by which inhaled aerosolized budesonide and salbutamol reduces OLV-induced injury to the collapsed lung is related to blocking HIF-1α/VEGF signaling pathway in lung tissues of rabbits. Key words: One-lung ventilation; Acute lung injury; Budesonide; Albuterol; Bronchodilator agents; Administration, inhalation

Acute lung injury model induced by single dose of paraquat intratracheal aerosolization in mice

Objective To establish a mouse model of acute lung injury (ALI) via intratracheal aerosolization of paraquat (PQ). Methods Thirty male C57BL/6J mice of 8-10 weeks old were randomly(random number) divided into the paraquat model group (n = 15) and the saline control group (n = 15). Mice in the paraquat model group were administered PQ solution (0.4 mg/mL) at a single dose of 50 μL per mouse via intratracheal aerosolization. Mice in the saline control group received an equal volume of saline. Mice were sacrificed 72 h post-PQ administration and samples were collected. The general physical condition of mice including body weight as well as mortality was monitored daily. Pulmonary function, cell counting and classification of bronchoalveolar lavage fluid (BALF), proinflammatory cytokines (TNF-α, IL-1β, and IL-6) levels of BALF and serum, MPO activity and total protein concentration of BALF and pathological lung injury scores were obtained. Results The body mass of mice decreased progressively within 72 h after PQ intratracheal administration. The static compliance of lung decreased (P<0.01) and the resistance increased (P<0.01). The number of inflammatory cells in BALF was significantly higher than that of the saline control group (all P<0.01), the levels of proinflammatory cytokines were significantly upregulated in both BALF and serum (all P<0.01), and the activity of MPO in BALF was also remarkedly increased (P<0.01). The total protein concentration of BALF was significantly elevated (P<0.01). The pathological observation of lung tissue showed a large number of inflammatory cells infiltration accompanying pulmonary hemorrhage, alveolar collapse, hyaline membrane formation and alveolar septal thickening, and the lung injury scores significantly increased (P<0.01). Conclusions Intratracheal aerosolization of a single dose of 0.02 mg PQ can successfully induce ALI in mice. Key words: Paraquat; Acute lung injury; Animal model; Intratracheal aerosolization

Respiratory viral infections occurring after hematopoietic stem cell transplantation.

Respiratory viral infection is one of the most crucial complications after hematopoietic stem cell transplantation (HSCT), which affects approximately 60% of HSCT recipients within one year after transplantation. Prevalence of progression from upper respiratory tract infection to lower respiratory tract disease (LRD) among HSCT recipients is 15-20% and day-90 mortality after LRD is as high as 40%. Risk factors for the progression to LRD are early infection after HSCT, low neutrophil or lymphocyte count, old age, and corticosteroid use. Aerosolized or oral ribavirin for respiratory syncytial virus infection and neuraminidase inhibitors for influenza are effective for the prevention of progression to LRD and mortality from LRD. Conversely, there are no definitive data concerning the efficacy of intravenous immunoglobulin. In cases of respiratory viral infection after HSCT, we recommend reduction of steroid dosage to less than 1 mg/kg/day, if applicable. Future directions for the management of respiratory viral infections in Japan are widespread availability of multiplex PCR testing and the introduction of new antiviral drugs.

Effect of sevoflurane on autophagy in lung tissues of asthmatic mice

Objective To investigate the effect of sevoflurane on autophagy in lung tissues of asthmatic mice. Methods Twenty-four SPF female C57BL/6 mice, aged 6-8 weeks, weighing 23-27 g, were randomly divided into 3 groups (n=8 each) using a random number table: control group, asthma group and sevoflurane group.The mice were sensitized with intraperitoneal ovalbumin 10 μg and 1 mg potassium aluminium sulfate in 0.5 ml of normal saline (NS) on 1st day of establishment of the model, and asthma was challenged with aerosolized 1% ovalbumin in 50 ml of NS for 30 min once a day for 7 consecutive days starting from 15th day in asthma group.Asthma was induced using the method mentioned above, and the sensitized animals inhaled 3% sevoflurane for 1 h after each challenge in sevoflurane group.In control group, potassium aluminium sulfate 1 mg in 0.5 ml of NS was intraperitoneally injected on 1st day of establishment of the model, and the mice were exposed to aerosolized 0.9% NS 50 ml for 30 min once a day for 7 consecutive days starting from 15th day.At 24 h after the last challenge, the lung was lavaged, and broncho-alveolar lavage fluid (BALF) was collected for determination of the inflammatory cell count and concentrations of interleukin-13 (IL-13) and IL-10 in BALF (by enzyme-linked immunosorbent assay). The lung tissues were taken for examination of the inflammatory cell infiltration and damage to the bronchial epithelia and to the structure of alveolus and for determination of Beclin-1 and microtubule-associated protein 1 light chain 3 (LC3) expression (by Western blot). Results Compared with control group, the inflammatory cell count and concentrations of IL-13 and IL-10 in BALF were significantly increased, and the expression of Beclin-1 and LC3 in lung tissues was significantly up-regulated in asthma group (P<0.05). Compared with asthma group, the inflammatory cell count and concentrations of IL-13 in BALF were significantly decreased, the IL-10 concentration in BALF was significantly increased, and the expression of Beclin-1 and LC3 in lung tissues was significantly down-regulated in sevoflurane group (P<0.05). There was significantly less inflammatory cell infiltration in lung tissues, necrosis and shedding of bronchial epithelial cells and alveolar wall disruption in sevoflurane group. Conclusion The mechanism by which sevoflurane inhibits airway inflammation is related to inhibition of autophagy in asthmatic mice. Key words: Asthma; Anesthetics, inhalation; Autophagy; Lung

Efficacy and toxicity of aerosolised colistin in ventilator-associated pneumonia: a prospective, randomised trial.

BackgroundCases of ventilator-associated pneumonia (VAP) due to multidrug-resistant (MDR) gram-negative bacilli (GNB) mainly Acinetobacter baumannii, Pseudomonas aeruginosa and enterobacteria are common in hospitalised patients of Tunisian intensive care units (ICUs). Parenteral colistin has been used for the therapy of VAP caused by MDR GNB at Tunisian hospitals over the past few years with a favourable clinical response. However, its use fell out of favour because of the reported drug-related nephrotoxicity and neurotoxicity.ObjectivesTo determine whether aerosolised (AS) colistin was beneficial and safe in therapy of gram-negative VAP.MethodsThis was a randomised, single-blind study, in 149 critically ill adults who developed gram-negative VAP. Included patients were divided into two groups whether they received AS colistin (intervention group; n = 73) or intravenous (IV) colistin (control group; n = 76). AS colistin was given as 4 million units (MU) by nebulisation three times per 24 h. IV colistin was given as a loading dose of 9 MU followed by 4.5 MU two times per 24 h. Patients were followed during 28 days. Primary outcome was cure of VAP assessed at day 14 of therapy and defined as resolution of clinical signs of VAP and bacteriological eradication. Secondary outcomes were incidence of acute renal failure (ARF), mechanical ventilation length, ICU length of stay and 28-day mortality. Results were analysed based on intention-to-treat concept.ResultsThe patient’s baseline characteristics and distribution of pathogens VAP in both groups were similar. The clinical cure rate was 67.1 % in AS group and 72 % in IV group (p = 0.59). When administered in monotherapy or in combination, the AS regimen was as effective as IV regimen. Patients in AS group had significantly lower incidence of ARF (17.8 vs 39.4 %, p = 0.004), more favourable improvement of P/F ratio (349 vs 316 at day 14, p = 0.012), shortened time to bacterial eradication (TBE) (9.89 vs 11.26 days, p = 0.023) and earlier weaning from ventilator in ICU survivors with a mean gain in ventilator-free days of 5 days. No difference was shown in the length of stay and the 28-day mortality.ConclusionAerosolised colistin seems to be beneficial. It provided a therapeutic effectiveness non-inferior to parenteral colistin in therapy of MDR bacilli VAP with a lower nephrotoxicity, a better improvement of P/F ratio, a shortened bacterial eradication time and earlier weaning from ventilator in ICU survivors.Trial registration ClinicalTrials.gov Identifier: NCT02683603

Prophylactic aerosolized tobramycin for the prevention of tracheitis in children

Prophylactic aerosolized tobramycin for the prevention of tracheitis in children

A randomized, controlled trial of an aerosolized vaccine against measles.

A randomized, controlled trial of an aerosolized vaccine against measles.

Immune complex disease in guinea pig lungs: elicitation with pigeon serum.

Immune complex- and T cell-mediated reactions to organic antigens appear to contribute to the pathogenesis of hypersensitivity pneumonitis in humans. Because pigeon serum is one of the reagents used by clinicians to diagnose this disease, we assessed its potential to elicit immune complex-mediated pulmonary inflammation in guinea pigs. Animals were immunized with different concentrations of pigeon serum protein emulsified in complete Freund's adjuvant, and serums were collected at 4-day intervals after the booster injection. The largest amounts of tissue-fixing (IgG1) and complement-fixing (IgG2) antibodies to pigeon serum were detected in guinea pigs immunized with 1.0 mg of pigeon serum protein 20 to 24 days after the secondary immunization. Therefore, the responses of these animals and of recipients of serum from these animals to aerosol challenge with either homologous (pigeon serum) or heterologous (bovine gamma globulin) immunogen was investigated. Actively and passively immunized guinea pigs developed pulmonary inflammation only after exposure to aerosolized pigeon serum. However, lesions were not observed in the lungs of complement-deficient recipients of immune serum that had inhaled homologous immunogen. These observations suggest that such pigeon serum-elicited pulmonary inflammation in guinea pigs is a manifestation of a complement-dependent, humoral-immune mechanism of pathogenesis and thus is consistent with an immune complex disease.

Aerosolized Measles Vaccine Fails Noninferiority Trial in India

Measles vaccine is usually given by subcutaneous injection. An aerosolized measles vaccine (AMV) could be administered by individuals with less training and would not require sterile needles and syringes. The technology has been developed, but previous trials comparing AMV with conventional subcutaneous measles vaccine (SMV) have shown inconsistent efficacy results. A new study, performed at eight primary care clinics in India, was …