Aerosolized Medications Delivered via Full-Face Noninvasive Ventilation and Ocular Complications in a Pediatric Intensive Care Unit

Abstract

Background: Many pediatric ICU (PICU) patients treated with noninvasive ventilation (NIV) for respiratory failure also receive aerosolized medications. There are concerns that aerosolized medications delivered via full-face mask could inadvertently deposit onto the eye, resulting in irritation or injury. Despite this concern, aerosolized medications via full-face and nasal interfaces are often administered to children. We hypothesized that aerosol medication delivery during NIV would not be associated with the development of ocular complications.

Methods: We retrospectively reviewed the medical records of children < 10 kg who received aerosolized medications during NIV or CPAP admitted to our PICU. We collected demographics, support modality, interface used, medications delivered, treatment tolerance, and any noted ocular complications upon hospital discharge. Respiratory therapist (RT) documentation was used to determine treatment tolerance (tolerated well, fairly well, poorly, or other). The occurrence of ocular complications was assessed through review of physical exam findings and discharge summaries.

Results: We included 36 children: 21 (58%) who received NIV or CPAP via full-face mask and 15 (42%) via nasal mask. A total of 299 aerosol treatments were delivered, including 84 treatments during NIV via full-face mask. Albuterol was the most commonly delivered medication, given to 15 (71%) children; 4 (19%) subjects received hypertonic saline, 4 (19%) received racemic epinephrine, 2 (10%) received dornase alfa, 2 (10%) received budesonide and 1 (5%) received acetylcysteine. Children received a median of 2.5 (1-6) treatments. No treatments were documented as having been poorly tolerated and no treatment-related ocular complications were noted. A total of 4 ocular abnormalities (nystagmoid jerks and cataracts) were noted upon hospital discharge, with 1 (5%) in a child receiving NIV through a full-face mask, and none were attributable to aerosolized medication delivery.

Conclusions: Aerosolized medications delivered through full-face mask were not associated with ocular complications at hospital discharge.