USE OF NEBULISER THERAPY IN INTENSIVE CARE UNIT

Use of Nebuliser Therapy in Intensive Care Unit



Use of Nebuliser Therapy in Intensive Care Unit

Introduction

Each year in the UK, around 500,000 patients require nebuliser therapy for more than 48 hours. These patients are at high risk of developing lung damage related to inflammatory mechanisms. Acute lung injury (ALI), one manifestation of inflammatory mediated lung damage, is present at the onset of prolonged nebulizer therapy in 18% of patients and subsequently develops in a further 26% of patients. The inflammatory triggers of lung damage include pneumonia, sepsis, aspiration, and trauma. Nebulizer therapy may also damage the lungs through ventilation-induced lung injury and ventilator-associated pneumonia (Byron, 2004, 33).

An important inflammatory mechanism of lung damage is fibrin deposition in the pulmonary microcirculation and in the alveolar sacs (hyaline membrane formation). This impairs both alveolar perfusion and ventilation.

Clinical and untested forms have illustrated that heparin or other anti-coagulants decrease fibrin deposition in the lungs and advance clinical outcomes. Heparin has other activities, encompassing decreased pulmonary edema, decreased leukocyte activation, and inhibition of adhesion of pathogens and viruses to respiratory exterior that may furthermore be beneficial. Evidence from large, multi-center, clinical investigations in patients with critical sepsis furthermore proposes that heparin may advance significant clinical outcomes. Post hoc investigation of three interventional investigations discovered that prophylactic subcutaneous heparin management was affiliated with decreased death (32% versus 42%, P = 0.0001). Furthermore, a later potential randomized study of subcutaneous heparin in patients treated with triggered protein C for critical sepsis furthermore discovered a tendency of smaller death (28% versus 32%, P = 0.08).

Indications for initiation of nebulizer support

Nebulizer therapy, in itself, is not a therapy for respiratory failure. It should be considered of as a procedure to support patients, endowing survival while the origin of the respiratory failure is came to and reversed. A corollary would be that nebulizer therapy is not demonstrated in moribund patients in who alleviation of the precipitating component is not anticipated. In supplement, when contemplating initiation of nebulizer therapy, much considered should be granted to the hurtful ventilation-related penalties that may perplex the course of the patient's illness (Byron, 2004, 141).

The major objectives of starting nebulizer therapy are: (1) to turn around hypoxaemia; (2) to turn around acute respiratory acidosis, proposing to ease life-threatening acidemia other than to normalize PaCO2; and (3) to ease respiratory anguish and increased work of breathing. From these objectives are drawn from the academic suggestions for initiation of nebulizer support.

 

Modes of nebulizer therapy

Continuous mandatory ventilation (CMV)

This mode consigns a set number of mechanical puffs of air, with a preset affected by surges capacity, at normal intervals. Classically, the patient is not permitted to wind in between mandatory breaths. This has directed to the recommendation that this mode should best be booked for the patient with no respiratory effort. Indeed, numerous ventilator emblems accessible today have no factual CMV mode; the assist-control mode is supplied instead. In the paralyzed or apneic patient, assist-control would function as if it were CMV (Pavia, ...