Aerosolized antibiotics in mechanically ventilated patients

Palmer, Lucy B.; Smaldone, Gerald C.; Simon, Sanford R.; O’Riordan, Thomas G.; Cuccia, Ann D

doi:10.1097/00003246-199801000-00013

Cited by 162 publications

(87 citation statements)

References 36 publications

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“…Aerosol delivery provides a means to achieve local effects in the lung with minimal systemic drug exposure [33]. Estimates of the current authors nebulisation system suggests that it deposits 12-20% of output to the 17th-23rd generation of the bronchials, the transitory zones leading to terminal alveolated lung [33].…”

Section: Discussionmentioning

confidence: 99%

Aerosol granulocyte-macrophage colony-stimulating factor for pulmonary alveolar proteinosis

Wylam¹

2006

Eur Respir J

116

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Recently, granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies have been found in many patients with pulmonary alveolar proteinosis (PAP). The present study reports a retrospective case series of patients who used aerosolised GM-CSF in the treatment of idiopathic PAP. Between 1999 and 2003, 12 patients elected to receive aerosolised GM-CSF (250 mg b.i.d. every other week) in lieu of whole-lung lavage or observation.Patient characteristics, pulmonary function tests, arterial blood gas analysis, laboratory values and chest radiographs were extracted from the patient's medical records. Of the six patients tested, all had GM-CSF neutralising antibodies. Additionally, abnormalities in GM-CSF gene expression (one patient), receptor expression (two patients) and ability to upregulate adhesion molecules (one patient) were found.All patients except one had a positive response (mean improvements in arterial oxygen tension, alveolar-arterial oxygen gradient, carbon monoxide diffusing capacity of the lung and forced vital capacity were 17.1 mmHg, 18.4 mmHg, 16.6% pred and 13.5% pred, respectively). Two patients made a complete recovery and were disease free 1 and 2 yrs after discontinuing treatment. Four patients showed complete response to both the initial course or when treated again for recurrence after discontinuation of treatment. One patient required dose escalation (500 mg b.i.d.) with complete response. GM-CSF was well tolerated without late toxicity after median (range) follow-up of 30.5 (3-68) months.In conclusion, aerosolised granulocyte-macrophage colony-stimulating factor is safe and effective in treating pulmonary alveolar proteinosis providing an alternative to whole-lung lavage or subcutaneous granulocyte-macrophage colony-stimulating factor.

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Section: Discussionmentioning

confidence: 99%

Aerosol granulocyte-macrophage colony-stimulating factor for pulmonary alveolar proteinosis

Wylam¹

2006

Eur Respir J

116

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“…LPS (endotoxin, O antigen) is a membrane structural component of all gram negative bacteria [31]. The structur al alterations of a bacterial membrane results in endotoxemia since one bacteria contain up to 3 500 000 LPS molecules.…”

Section: Resultsmentioning

confidence: 99%

Early Evaluation of the Efficiency of Antibiotic Therapy for Nosocomial Pneumonia by Quantifying Lipopolysaccharide

Яковлев¹,

Gushchina²,

Ниязматов³

et al. 2013

rmt

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“…When used continually, rather than intermittently, oropharyngeal antibiotics were associated with an increased incidence of pneumonia with resistant bacteria and this regimen was abandoned (Feeley et al 1975). Palmer et al (1998) demonstrated that nebulised antibiotics can be effectively delivered to patients receiving mechanical ventilation, with measurable changes in clinical and airway inflammatory indicators (decreased levels of inflammatory cells and mediators), significant reduction in sputum volume, and eradication of P. aeruginosa and other Gram-negative pathogens in most cases. The study involved only six patients who received nine courses of either nebulised gentamicin or amikacin for 14±21 days.…”

Section: Aerosolised Antibioticsmentioning

confidence: 99%

Pharmaceutical strategies to prevent ventilator-associated pneumonia

McCrory

Jones

Adair

et al. 2003

Journal of Pharmacy and Pharmacology

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The increasing incidence of hospital-acquired (nosocomial) infection is a disturbing phenomenon resulting in significant patient mortality and putting considerable strain on healthcare budgets and personnel. One particularly serious aspect of nosocomial infection is that of ventilator-associated pneumonia (VAP). This arises in patients who receive mechanical ventilation within the intensive care unit. The quoted incidence of VAP varies widely (5-67%) and the reported mortality of patients with VAP is in the range of 24-71%. This review will examine the many factors that account for these wide ranges reported, including the patient population under investigation, the causative organism, the method of diagnosis, interventions employed and preventative strategies. The use of bioactive and drug-impregnated biomaterials for endotracheal tube construction is discussed as novel approaches to the prevention of VAP.

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Aerosolized antibiotics in mechanically ventilated patients

Abstract: Nebulizer delivery of aerosolized aminoglycosides is efficient and predictable. In our clinical model, aerosolized antibiotics can make a significant impact on respiratory secretions. Their efficacy in treatment of critically ill patients remains to be determined.

Cited by 162 publications

References 36 publications

Aerosol granulocyte-macrophage colony-stimulating factor for pulmonary alveolar proteinosis

Aerosol granulocyte-macrophage colony-stimulating factor for pulmonary alveolar proteinosis

Early Evaluation of the Efficiency of Antibiotic Therapy for Nosocomial Pneumonia by Quantifying Lipopolysaccharide

Pharmaceutical strategies to prevent ventilator-associated pneumonia

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