@article {Sol{\'e}-Lleonartrespcare.04519, author = {Candela Sol{\'e}-Lleonart and Jean-Jacques Rouby and Jean Chastre and Garyfallia Poulakou and Lucy B Palmer and Stijn Blot and Tim Felton and Matteo Bassetti and Charles-Eduard Luyt and Joao Manuel Pereira and Jordi Riera and Tobias Welte and Jason A Roberts and Jordi Rello}, title = {Intratracheal Administration of Antimicrobial Agents in Mechanically Ventilated Adults: An International Survey on Delivery Practices and Safety}, elocation-id = {respcare.04519}, year = {2016}, doi = {10.4187/respcare.04519}, publisher = {Respiratory Care}, abstract = {BACKGROUND: Intratracheal antibiotic administration is increasingly used for treating respiratory infections. Limited information is available on delivery devices, techniques, and safety.METHODS: An online survey on intratracheal administration of anti-infective agents in mechanically ventilated adults was answered by health-care workers from 192 ICUs to assess the most commonly used devices, current delivery practices, and safety issues. We investigated whether ICU usage experience (>=3 y) impacted its performance.RESULTS: Intratracheal antibiotic administration was a current practice in 87 ICUs (45.3\%), with 40 (46\%) having experience with the technique (>=3 y). Sixty-six (78.6\%) of 84 health-care workers reported avoiding intratracheal antibiotic administration due to an absence of evidence-based guidelines (78.6\%). Jet nebulizers were the most commonly used devices for delivery, in 24 less experienced ICUs (27.6\%) and in 18 (20.7\%) experienced ICUs. Direct tracheal instillation (6; 6.9\%) was still considered for drug prescription in 12 ICUs (6.9\%). More experience resulted in neither greater adherence to measures improving the drug{\textquoteright}s delivery efficiency (93 measures in the experienced group; 27.9\%) nor a greater adoption of measures to increase safety. Indeed, the expiratory filter was changed after each nebulization in only 2 experienced ICUs (6.9\%), whereas 15 (51.7\%) changed it daily instead.CONCLUSIONS: Intratracheal antibiotic administration is a common therapeutic modality in ICUs, but inadequate practices were widely encountered, independent of the level of experience with the technique. This suggests a need to develop standardization to reduce variability and improve safety and efficacy.}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/early/2016/03/08/respcare.04519}, eprint = {https://rc.rcjournal.com/content/early/2016/03/08/respcare.04519.full.pdf}, journal = {Respiratory Care} }