- Author
-
S.M. van der Hoeven
- Title
- Nebulization of mucolytic agents and bronchodilating drugs for ICU patients receiving invasive ventilation
- Supervisors
-
M.J. Schulz
- Co-supervisors
-
F. Paulus
- Award date
- 12 November 2020
- Number of pages
- 185
- ISBN
- 9789464160772
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
Artificial ventilation and the presence of an endotracheal tube or trachea cannula are associated with increased mucus production and impaired airway clearance. Accumulation of airway secretions can lead to mucus plugging in the airway, and consequently cause atelectasis and airway colonization. The first can lead to oxygenation problems, the second may cause respiratory infections.
Preventive routine nebulization of mucolytics, often combined with a bronchodilator, has been suggested to prevent these problems, though this was never tested in a robust study. The national multicenter randomized clinical non-inferiority trial, named NEBULAE, showed an on-demand nebulization strategy to be non-inferior to a preventive routine nebulization strategy with respect to the duration of invasive ventilation, and the proportion of endotracheal tube obstructions. Preventive routine nebulizations, however, led to more adverse events. And were more expensive then on-demand nebulizations. A national survey showed that the preventive nebulization strategy was practiced in many Dutch ICU’s. In a before and after study, successful and sustained de-implementation of preventive routine nebulizations was achieved in one center. - Persistent Identifier
- https://hdl.handle.net/11245.1/a7b2732e-f2b3-4bfc-99a9-b9ebf897a32f
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: General introduction and outline of the thesis
Chapter 2: Preventive nebulization of mucolytic agents and bronchodilating drugs in invasively ventilated intensive care unit patients (NEBULAE): Study protocol for a randomized controlled trial
Chapter 3: Effect of on-demand vs. routine nebulization of acetylcysteine with salbutamol on ventilator-free days in intensive care unit patients receiving invasive ventilation a randomized clinical trial
Chapter 4: Effect of routine vs. on–demand nebulization of acetylcysteine with salbutamol on accumulation of airway secretions in endotracheal tubes – Substudy of a randomized clinical trial
Chapter 5: Costs of two strategies of nebulizations of acetylcysteine and salbutamol in invasively ventilated intensive care unit–patients – A preplanned economic evaluation within a randomized controlled trial
Chapter 6: Airway care interventions in invasively ventilated critically ill patients – A survey into current practice
Chapter 7: De-implementation of routine nebulization of acetylcysteine with salbutamol in intensive care unit patients receiving invasive ventilation
Chapter 8: Summary
Chapter 9: General discussion
Chapter 10: Nederlandse samenvatting
Affiliations of contributing authors; PhD portfolio; List of publications; Curriculum vitae; Dankwoord
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