Abstract
Aerosols have gained wide acceptance over the past 10 years for the treatment of obstructive diseases. However, much controversy still exists about their use and mode of administration in the setting of intensive care units for intubated patients. The current literature was reviewed addressing the following question: In intubated and mechanically ventilated patients with airway obstruction, should bronchodilator aerosols be delivered through a metered-dose inhaler (MDI) or a nebulizer in order to reduce complications associated with high airway resistance? Most often investigators have examined, in uncontrolled trials, the effect of bronchodilator aerosols administered either through MDIs or nebulizers in lung models, or in populations of patients with heterogeneous conditions. An extremely wide range of bronchodilator dosages has been studied. Clinical outcomes have consisted of either drug deposition or lung mechanical characteristics. Only three randomized controlled trials comparing the effects of bronchodilator aerosols delivered through a nebulizer to those delivered through an MDI have been published, without clearly demonstrating the superiority of one mode of administration over the other. There is a need for randomized controlled trials comparing the effect of bronchodilator aerosols delivered through nebulizer versus MDI on the incidence of ventilator-associated complications in mechanically ventilated patients with obstructive lung diseases.