Practice pattern of aerosol drug therapy in ARDS patients: A secondary analysis of the Aero-in-ICU study

Background

The potential role of aerosol drug therapy (ADT) in patients with acute respiratory distress syndrome (ARDS) remains uncertain. The objective of this study is to determine the prevalence and practice patterns of ADT in patients with ARDS.

Methods

This secondary analysis of a prospective observational multi-centric cohort study done in critically ill patients to know the ADT practice pattern was conducted in nine participating intensive care units (ICUs) across India between November 2022 and March 2023. The study recruited newly admitted adult patients (age >18 years) who had an artificial airway and required mechanical ventilation (invasive or non‑invasive). These patients were followed up for the next 14 days or until ICU discharge or death. This secondary analysis collected data about screened patients with ARDS, related to each aerosol therapy including ongoing respiratory support, type of drug, and aerosol‑generating device, including ongoing respiratory support, type of drug, and aerosol‑generating device.

Results

Fifty-three (24.3%) of the 218 patients had ARDS, with a mean age of (60.2±14.8) years. At admission, the acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA) score of the recruited patients were 17.4±7.1 and 7.7±4.0, respectively. Respiratory support was provided with invasive mechanical ventilation (IMV) alone, non-invasive ventilation (NIV) alone, or both in 45.3%, 24.5%, and 30.2% of patients, respectively. The mean duration of the ICU stay was (6.4 ± 4.0) days. Of the 53 patients with ARDS, 51 (96.2%) received 1285 aerosol sessions during follow-up for 330 patient days. Of all patients with ARDS who received aerosol therapy, 71.4% were prescribed while on IMV and 25.7% on NIV. A single drug was used in 60.7% of the aerosol sessions used a single drug, and 39.3% were prescribed combination drugs. Shorter-acting bronchodilators were the predominant drugs, with jet nebulizers (55.4%) being the most commonly used aerosol generators. These were followed by ultrasonic (23.1%) and vibrating-mesh nebulizers (21.5 %). During IMV, only in 50.1% of aerosol sessions (460 out of 918) was an aerosol generator placed at the optimum position (15–30 cm away from the Y-junction).

Conclusions

Aerosol therapy is frequently used in ARDS, with bronchodilators being the most common drug. The jet nebulizer is the most familiar aerosol-generating device, but only half of the aerosol sessions are at the optimum position during invasive mechanical ventilation.