Ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria: understanding nebulization of aminoglycosides and colistin

Rouby, Jean‐Jacques; Solé-Lleonart, Candela; Rello, Jordi

doi:10.1007/s00134-019-05890-w

Cited by 37 publications

(33 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The VMN was placed at the dry side of the humidifier. A lung protective, low tidal volume ventilation strategy of 8 mL/Kg for a 69 Kg adult was adopted (Vt 550 mL, RR 13 BPM, and I:E Ratio 1:2) [ 64 ]. The capture filter was placed between the endotracheal tube (ETT) (Flexicare, 8.00 mm, UK) and a test lung (IMT Medical, Bachs Switzerland).…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Aerosol Therapy during the Escalation of Care in a Model of Adult Cystic Fibrosis

et al. 2021

View full text Add to dashboard Cite

Lung disease is the main cause of morbidity and mortality in cystic fibrosis (CF). CF patients inhale antibiotics regularly as treatment against persistent bacterial infections. The goal of this study was to investigate the effect of clinical intervention on aerosol therapy during the escalation of care using a bench model of adult CF. Droplet size analysis of selected antibiotics was completed in tandem with the delivered aerosol dose (% of total dose) assessments in simulations of various interventions providing oxygen supplementation or ventilatory support. Results highlight the variability of aerosolised dose delivery. In the homecare setting, the vibrating mesh nebuliser (VMN) delivered significantly more than the jet nebuliser (JN) (16.15 ± 0.86% versus 6.51 ± 2.15%). In the hospital setting, using VMN only, significant variability was seen across clinical interventions. In the emergency department, VMN plus mouthpiece (no supplemental oxygen) was seen to deliver (29.02 ± 1.41%) versus low flow nasal therapy (10 L per minute (LPM) oxygen) (1.81 ± 0.47%) and high flow nasal therapy (50 LPM oxygen) (3.36 ± 0.34%). In the ward/intensive care unit, non-invasive ventilation recorded 19.02 ± 0.28%, versus 22.64 ± 1.88% of the dose delivered during invasive mechanical ventilation. These results will have application in the design of intervention-appropriate aerosol therapy strategies and will be of use to researchers developing new therapeutics for application in cystic fibrosis and beyond.

show abstract

Section: Methodsmentioning

confidence: 99%

Evaluation of Aerosol Therapy during the Escalation of Care in a Model of Adult Cystic Fibrosis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…These very high doses were based on studies performed in 2008-2010 in anesthetized and mechanically ventilated piglets whose lungs were infected by the bronchial inoculation with high concentrations of P. aeruginosa [42]. The nebulization of 100,000 IU/kg of CMS could eradicate the causative microorganism from 67% of the infected pulmonary segments within 24 h. These very high doses are actually recommended [43]. In 2018, a meta-analysis performed on 12 studies published between 2005 and 2016 [15,18,19,22,[26][27][28][32][33][34]36,37] reported the effectiveness of nebulized CMS as a monotherapy for treating respiratory tract infections caused by MDR and/or CMS only susceptible GNB [44].…”

Section: Treatment Of Mdr Gnb Ventilator-associated Pneumoniamentioning

confidence: 99%

“…Optimizing lung deposition of CMS to provide effective bacterial killing in critically ill patients with VAP and VAT requires a specific nebulization strategy including [43,53,94]: (1) the preferential use of vibrating mesh nebulizers positioned 15 cm before the Y piece; (2) the use of continuous rather than breath-synchronous nebulization to allow the nebulization of high doses of CMS; (3) the use of specifically designed respiratory circuits with smooth inner surfaces and avoiding sharp angles to decrease turbulence and circuit deposition; (4) the use of specific ventilator settings to limit circuit and tracheobronchial impaction of aerosolized particles: volume controlled mode with constant inspiratory flow, tidal volume 8 mL/kg, respiratory frequency 12 to 15 bpm, inspiratory: expiratory ratio 50%, inspiratory pause 20% and positive end-expiratory pressure 5 to 10 cm H 2 O; (5) the administration of a short-acting sedative agent to ensure coordination between the patient and the ventilator;…”

Section: Administration and Dosing Of Nebulized Colistimethate Sodium 61 Technique Of Nebulizationmentioning

confidence: 99%

See 1 more Smart Citation

Nebulized Colistin in Ventilator-Associated Pneumonia and Tracheobronchitis: Historical Background, Pharmacokinetics and Perspectives

et al. 2021

View full text Add to dashboard Cite

Clinical evidence suggests that nebulized colistimethate sodium (CMS) has benefits for treating lower respiratory tract infections caused by multidrug-resistant Gram-negative bacteria (GNB). Colistin is positively charged, while CMS is negatively charged, and both have a high molecular mass and are hydrophilic. These physico-chemical characteristics impair crossing of the alveolo-capillary membrane but enable the disruption of the bacterial wall of GNB and the aggregation of the circulating lipopolysaccharide. Intravenous CMS is rapidly cleared by glomerular filtration and tubular excretion, and 20–25% is spontaneously hydrolyzed to colistin. Urine colistin is substantially reabsorbed by tubular cells and eliminated by biliary excretion. Colistin is a concentration-dependent antibiotic with post-antibiotic and inoculum effects. As CMS conversion to colistin is slower than its renal clearance, intravenous administration can lead to low plasma and lung colistin concentrations that risk treatment failure. Following nebulization of high doses, colistin (200,000 international units/24h) lung tissue concentrations are > five times minimum inhibitory concentration (MIC) of GNB in regions with multiple foci of bronchopneumonia and in the range of MIC breakpoints in regions with confluent pneumonia. Future research should include: (1) experimental studies using lung microdialysis to assess the PK/PD in the interstitial fluid of the lung following nebulization of high doses of colistin; (2) superiority multicenter randomized controlled trials comparing nebulized and intravenous CMS in patients with pandrug-resistant GNB ventilator-associated pneumonia and ventilator-associated tracheobronchitis; (3) non-inferiority multicenter randomized controlled trials comparing nebulized CMS to intravenous new cephalosporines/ß-lactamase inhibitors in patients with extensive drug-resistant GNB ventilator-associated pneumonia and ventilator-associated tracheobronchitis.

show abstract

“…[ 6 – 8 ] Western medicine routine treatment mainly uses antibiotics (penicillins, cephalosporins, macrolides, and aminoglycosides etc.) [ 12 – 21 ] and antiviral drugs (interferon and ribavirin). [ 22 – 25 ] However, the evaluation of their efficacy is not scientific and systematic.…”

Section: Introductionmentioning

confidence: 99%

Reduning injection combined with western medicine for pneumonia

Cao¹,

Zhen²,

Kuang³

et al. 2020

Medicine

View full text Add to dashboard Cite

Background: Pneumonia is a common respiratory disease. In severe cases, it can induce cardiovascular disease and even life-threatening. In particular, pneumonia caused by the new coronavirus (SARS-CoV-2) that broke out at the end of 2019 has seriously affected the health of people in all countries. In recent years, it has been treated with the combination of traditional Chinese medicine (TCM) (such as Reduning injection) and Western medicine, and its mortality has decreased significantly. But their efficacy has not been scientifically and systematically assessed. Accordingly, it is essential to provide a systematized review program to estimate the efficacy and safety of Reduning injection combined with Western medicine to treat pneumonia. Methods: The following databases are retrieved from start to September 2020: Pubmed, Cochrane Library, EMBASE, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Wanfang database, the Chongqing VIP Chinese Science and Technology Periodical Database (VIP) databases, Chinese Biomedical Literature Database (CBM), and other databases, which are absorbed into clinical RCTs of pneumonia using western medicine alone or plus Reduning injections. The selection of studies, data extraction, and assessment of risk of bias will be performed independently by 2 reviewers. At the same time, Review Manager V.5.3.5 (Rev Man V.5.3.5) was used for bias risk assessment and data synthesis. Results: The efficacy and safety of Reduning injection combined with western medicine in the treatment of pneumonia were evaluated in terms of overall effective rate, the patient's antipyretic time, antitussive time, rales disappearing time, X-ray recovery time, and the incidence of adverse reactions. Conclusions: This study provides reliable evidence-based support for the clinical application of Reduning injection combined with western medicine for pneumonia. Ethics and dissemination: Ethical approval is not required in this secondary research evidence, and we will publish the results of this study in a journal or relevant conferences. Registration number: DOI 10.17605/OSF.IO/VS75Y.

show abstract

Ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria: understanding nebulization of aminoglycosides and colistin

Cited by 37 publications

References 18 publications

Evaluation of Aerosol Therapy during the Escalation of Care in a Model of Adult Cystic Fibrosis

Evaluation of Aerosol Therapy during the Escalation of Care in a Model of Adult Cystic Fibrosis

Nebulized Colistin in Ventilator-Associated Pneumonia and Tracheobronchitis: Historical Background, Pharmacokinetics and Perspectives

Reduning injection combined with western medicine for pneumonia

Contact Info

Product

Resources

About