喘息やCOPDをもつ患者に挿管やNIVを行う場合、人工呼吸中も吸入薬を使いたいですよね。では、どんなデバイスをどこに接続して使えばいいでしょうか？そんな疑問には、こちらのステートメントをぜひ読んでみて下さい。
Aerosol therapy in adult critically ill patients: a consensus statement regarding aerosol administration strategies during various modes of respiratory support
Li J, Liu K, Lyu S, et al. Ann Intensive Care. 2023;13(1):63.
Background: Clinical practice of aerosol delivery in conjunction with respiratory support devices for critically ill adult patients remains a topic of controversy due to the complexity of the clinical scenarios and limited clinical evidence.
Objectives: To reach a consensus for guiding the clinical practice of aerosol delivery in patients receiving respiratory support (invasive and noninvasive) and identifying areas for future research.
Methods: A modified Delphi method was adopted to achieve a consensus on technical aspects of aerosol delivery for adult critically ill patients receiving various forms of respiratory support, including mechanical ventilation, noninvasive ventilation, and high-flow nasal cannula. A thorough search and review of the literature were conducted, and 17 international participants with considerable research involvement and publications on aerosol therapy, comprised a multi-professional panel that evaluated the evidence, reviewed, revised, and voted on recommendations to establish this consensus.
Results: We present a comprehensive document with 20 statements, reviewing the evidence, efficacy, and safety of delivering inhaled agents to adults needing respiratory support, and providing guidance for healthcare workers. Most recommendations were based on in-vitro or experimental studies (low-level evidence), emphasizing the need for randomized clinical trials. The panel reached a consensus after 3 rounds anonymous questionnaires and 2 online meetings.
Conclusions: We offer a multinational expert consensus that provides guidance on the optimal aerosol delivery techniques for patients receiving respiratory support in various real-world clinical scenarios.
PMID: 37436585
修正Delphi法により20個の推奨がされています。Fig. 3がグラフィカルにまとまっていて分かりやすいですね。基本的に、ジェットネブライザーより振動メッシュネブライザーかpMDI+スペーサーを使用して、加湿器は止めず、呼吸器設定も変更せずという感じです。