Nebulizer Use in ICU Settings

Main Nebulizer Types and Characteristics

The American Thoracic Society notes that jet nebulizers require a driving gas source with flow rates of 6-8 L/min 2
The American College of Chest Physicians recommends that design of jet nebulizers potentially allows gravitational flow of patient's secretions into medication reservoir, causing contamination 1
The American College of Chest Physicians states that continuous airflow in jet nebulizers contributes to higher aerosol dispersion to the environment compared to other nebulizer types 1
The American College of Chest Physicians notes that vibrating mesh nebulizers do not require a driving gas, which is advantageous in settings where gas supply is limited 1
The American College of Chest Physicians recommends that medication chamber in vibrating mesh nebulizers is physically separated from patient's secretions, reducing contamination risk 1
The American College of Chest Physicians states that ultrasonic nebulizers have an open connection between patient and solution chamber, similar to jet nebulizers 1
The American College of Chest Physicians notes that ultrasonic nebulizers are unable to nebulize suspensions and may denature some medications, limiting their use with certain drugs 1

The American Thoracic Society recommends using face masks for acutely ill patients, but notes that they may generate higher fugitive aerosol compared to mouthpieces 1, 2
The American Thoracic Society states that mouthpieces generate less fugitive aerosol than face masks and are preferred for nebulized steroids and antibiotics 1, 2
The American College of Chest Physicians notes that T-pieces can be used for connecting nebulizers to tracheostomy tubes in spontaneously breathing patients 1
The American College of Chest Physicians recommends connecting nebulizers in-line with ventilator circuits for patients requiring respiratory support 1, 3
The American College of Chest Physicians states that high-flow nasal cannula can be used with nebulizers, with fugitive aerosol emission decreasing as flow rate increases 1

The American Thoracic Society notes that aerosol deposition is reduced during mechanical ventilation compared to spontaneous breathing 3
The American Thoracic Society recommends three main methods for aerosol administration in ventilated patients, including metered-dose inhaler with spacer, inspiratory phase activated jet nebulizer, and ultrasonic nebulizer 3
The American Thoracic Society states that nebulizers should not be left permanently in line with ventilator circuits and should be cleaned between nebulizations to prevent bacterial aerosols 3

The American Thoracic Society recommends using nebulizers to deliver bronchodilators, steroids, antibiotics, and other medications in ICU settings 2
The American Thoracic Society notes that particle size of 2-5 μm is optimal for reaching the small airways 2, 4

The American College of Chest Physicians states that higher risk of fugitive aerosol emissions is associated with jet nebulizers compared to vibrating mesh nebulizers 1
The American College of Chest Physicians recommends cleaning nebulizers after each use, especially when used for antibiotics, to prevent bacterial growth 5
The American Thoracic Society notes that single-patient use equipment is recommended to prevent cross-contamination 5

The American Thoracic Society recommends using flow rate of 6-8 L/min to generate optimal particle size 2
The American Thoracic Society states that oxygen should be used as driving gas for patients with acute severe asthma due to hypoxia risk 2
The American Thoracic Society notes that air should be used as driving gas for COPD patients to avoid carbon dioxide retention 2
The American Thoracic Society recommends using volume of fluid in nebulizer chamber of 2.0-4.5 ml 2
The American Thoracic Society states that nebulization time is typically 10 minutes for bronchodilators, but may be longer for antibiotics and other medications 2