• Candela Solé-Lleonart, Jean-Jacques Rouby, Jean Chastre, Garyfallia Poulakou, Lucy B Palmer, Stijn Blot, Tim Felton, Matteo Bassetti, Charles-Eduard Luyt, Joao Manuel Pereira, Jordi Riera, Tobias Welte, Jason A Roberts, and Jordi Rello.
• University of Toronto, UHN & Mount Sinai Hospital, Toronto, Canada and Universitat Autonoma de Barcelona, Barcelona, Spain.
• Respir Care. 2016 Aug 1; 61 (8): 1008-14.

BackgroundIntratracheal antibiotic administration is increasingly used for treating respiratory infections. Limited information is available on delivery devices, techniques, and safety.MethodsAn online survey on intratracheal administration of anti-infective agents in mechanically ventilated adults was answered by health-care workers from 192 ICUs to assess the most commonly used devices, current delivery practices, and safety issues. We investigated whether ICU usage experience (≥3 y) impacted its performance.ResultsIntratracheal antibiotic administration was a current practice in 87 ICUs (45.3%), with 40 (46%) having experience with the technique (≥3 y). Sixty-six (78.6%) of 84 health-care workers reported avoiding intratracheal antibiotic administration due to an absence of evidence-based guidelines (78.6%). Jet nebulizers were the most commonly used devices for delivery, in 24 less experienced ICUs (27.6%) and in 18 (20.7%) experienced ICUs. Direct tracheal instillation (6; 6.9%) was still considered for drug prescription in 12 ICUs (6.9%). More experience resulted in neither greater adherence to measures improving the drug's delivery efficiency (93 measures in the experienced group; 27.9%) nor a greater adoption of measures to increase safety. Indeed, the expiratory filter was changed after each nebulization in only 2 experienced ICUs (6.9%), whereas 15 (51.7%) changed it daily instead.ConclusionsIntratracheal antibiotic administration is a common therapeutic modality in ICUs, but inadequate practices were widely encountered, independent of the level of experience with the technique. This suggests a need to develop standardization to reduce variability and improve safety and efficacy.Copyright © 2016 by Daedalus Enterprises.

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