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

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