Closed and open suction had the same VAP outcomes and costs (Intens Care Med 2006;32:538)
Metaanalysis Inten Care Med 2006;32:1329
Another MA of closed/open Crit Care Med 2007;35(1):260
- Factors that influence the efficacy of aerosol delivery in the mechanically ventilated patient include33:
- Position of administration in the circuit: the MDI should be closer to the endotracheal tube at the Y-piece with a chamber, compared with a pneumatic nebulizer, which should be at least 30 cm from the Y-piece. (Study)
- Humidification: this can decrease aerosol delivery to the respiratory tract because of greater deposition in the ventilator circuit. Higher doses may be required to achieve the desired effect.
- Timing of delivery: the aerosol should be delivered during the inspiratory phase to maximize drug delivery.
- Flow rates: slower inspiratory flow rates (and therefore longer inspiratory time) increase delivery of nebulized medications. A decelerating flow pattern can also increase delivery to the lower airways.
- Tidal volumes: larger tidal volumes greater than 500 mL ensure optimal delivery.
- Endotracheal tube size: tube sizes less than 7.0 mm reduce delivery.
- Density of inhaled gas: low-density gases such as helium-oxygen mixtures increase deposition to the lower airways by increasing laminar flow and producing smaller respirable particle size. (Critcaretextonline.com)
Curr Opin Crit Care 2007;13:27 review of inhalation therapy in vent pts
nebulizers may increase the rate of vap (Crit Care Med 2011;39:725)
How to use MDIs with the Vent
That is a 60 ml syringe; thread it into one of the ports or better yet, place an IV cath through the vent tubing and attach a medlock, tape it down.