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Table 3 Key good practices for optimal antibiotic nebulization during mechanical ventilation

From: Nebulized antibiotics in mechanically ventilated patients: a challenge for translational research from technology to clinical care

Organization Use standard operating procedures and a checklist. Ensure adequate staff training
Nebulizer Use nebulizers with a small residual volume
Do not operate jet nebulizers with gas external to the ventilator
Medication solution Use solutions for inhalation
Nebulizer position Position the nebulizer (continuous delivery) upstream in the inspiratory limb at 15–40 cm of the Y-piece
Humidification Remove the heat and moisture exchanger during nebulization; if using a heated humidifier, consider switching it off or use of a dry circuit
Ventilator settings Volume-controlled constant flow ventilation. Use low respiratory rate, low inspiratory flow and a long inspiratory time
Safety Place a new filter between the expiratory limb and the ventilator for each nebulization
Monitor patients closely during the nebulization, particularly in regard to airway pressure, arterial pressure and oxygen saturation
Check for resumption of humidification at the end of the nebulization