Nebulisation in the ICU

Dr Malcolm Sim

Nebulisation permits non-invasive drug delivery through the lung, providing a large surface area for rapid drug absorption through the thin, alveolar membrane. However, efficiency of nebulisers remained largely unchanged since the introduction of jet nebulisers almost 200 years ago. More efficient aerosol delivery has been facilitated by the more recent introduction of vibrating mesh nebulisers capable of aerosolising proteins, peptides, suspensions and drugs across the complete spectrum of MV, NIV, HFNC and spontaneous breathing. This opens the door to delivery of local antibiotics, vaccines, cell therapy, pulmonary vasodilators, muco-actives, anti-coagulants, local anaesthetics and anti-inflammatories as well as more efficient delivery of bronchodilators with potential to improve patient outcomes in multiple disease settings within the ICU.