Conference Coverage

On-demand nebulization in ICU equivalent to standard

Dr. Eric J. Gartman

Eric Gartman, MD, FCCP, comments: I would not say there is necessarily a standard way people do this, and practice patterns likely vary widely. There are some places where respiratory therapy has wide control of vented patients and often implements protocols, while at other places every vented patient has to have specific orders for things by the providers. I would find it very likely that more patients receive standing bronchodilator therapy than should (thus the reason for the study). Our practice pattern locally mirrors the idea of the study (where a patient's therapy is tailored to the reason for their intubation).

I would suspect local practice patterns with nebulized acytylcysteine to vary even more widely than bronchodilator administration strategies.


 

REPORTING FROM CCC47

The median number of ventilator-free days was 21 for the on-demand group and 20 for the routine group, said the paper.

The length of stay, mortality, and proportion of patients developing pulmonary complications did not differ between the two study arms, the investigators also reported in JAMA.

However, adverse events occurred in just 13.8% of the on-demand group, compared with 29.3% of the routine group (P less than .001), with the difference in adverse events mainly attributable to less tachyarrhythmia and agitation in the experimental group, according to the researchers.

Dr. Paulus and coauthors reported no conflicts of interest related to the study.

SOURCE: Paulus F et al. (van Meenen DMP et al.) JAMA. 2018 Feb. doi: 10.1001/jama.2018.0949.

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