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 |