I've got this posted in all the ICU forums...just wondering how many ICU's out there use inline suction and if you do, do you use polymixinB down the ETT when suctioning as a VAP preventative? I am trying to find out if this is common. We use this on all pts with inlines in my NICU but the PICU/CICU do not and there is no official policy for it. I found some scattered research dated a few years back that some studies showed its usefulness while others couldn't argue either way.
Thanks for the input!
Jul 31, '11
Is that just a specific pulmonologist? Maybe it's just his preference.
Aug 7, '11
how old is this doctor? that was popular in the 70s with both instillation and atomizing antibiotics for prevention.
there are other methods to prevent vap without the concerns of direction instillation of antibiotics. of course aerosolized antibiotics are sometimes used to reduce the colonization and for treatment. but, silver (oldie but goodie) lined et tubes, new shapes and materials for the cuffs and the subglottic suction tubes are being used along with other preventative measures.
quote from another article: (the references cited are also worthy of reading but some are from the past but their concerns still are notable today with what we know about about resistant bacteria.)
local instillation and aerosolized antibiotics
local instillation or aerosolization is a way to enhance antibiotic penetration to the lower respiratory tract. in the past, the agents most commonly administered and studied in this fashion have been the aminoglycosides and polymyxin b ([color=#202088]255
). only a single prospective randomized trial has examined the impact of the adjunctive use of locally instilled tobramycin with intravenous therapy in the treatment of vap ([color=#202088]256
). although the addition of endotracheal tobramycin did not improve clinical outcome compared with placebo, microbiologic eradication was significantly greater in the patients receiving aerosolized antibiotics. the small number of patients in this study suggests that more data are needed on this type of therapy before determining its value.
aerosolized antibiotics may also be useful to treat microorganisms that, on the basis of high mic values, are "resistant" to systemic therapy. anecdotal reports have appeared of patients with vap due to mdr p. aeruginosa
that is unresponsive to systemic antibiotics, but who have improved with the addition of aerosolized aminoglycosides or polymyxin b ([color=#202088]255
). concern about aerosolized antibiotics leading to an increased risk of pneumonia due to resistant microorganisms was raised when these agents were used as prophylaxis, not as therapy ([color=#202088]257
). one side effect of aerosolized antibiotics has been bronchospasm, which can be induced by the antibiotic or the associated diluents present in certain preparations. the committee believed that further investigation into the use of aerosolized antibiotics is warranted.