Intravenous furosemide vs nebulized furosemide in patients with pulmonary edema: A randomized controlled trial

Effect of Nebulized Furosemide on the Mortality of Adult, Mechanically Ventilated Acute Respiratory Distress Syndrome (ARDS) Patients: Protocol of a Randomized Clinical Trial (The ENHALE Trial)

Background Acute respiratory distress syndrome (ARDS) affects a significant proportion of ICU patients and has a high mortality rate. The inflammation of the alveolar-capillary membrane is pathognomonic and characterized by increased capillary permeability and pulmonary edema. A safe, readily available anti-inflammatory agent delivered directly to the lungs could be a promising therapeutic approach. All these properties apply to nebulized furosemide. Objectives The primary objective of this study is to analyze 28-day all-cause ICU mortality while the secondary objectives include assessing hospital mortality, ICU and hospital length of stay (LOS), ventilator-free days at 28 days, successful extubation rate, and adverse events. Methods A double-blind, placebo-controlled, parallel-arm superiority RCT using an intention-to-treat (ITT) analysis to assess whether nebulized furosemide reduces mortality in adult mechanically ventilated ARDS patients will be employed. Results The results of descriptive and inferential analyses will be tabulated, and the significant results will be presented.

Nebulized medications in the emergency department: A narrative review of nontraditional agents

PURPOSE

This article summarizes emerging nontraditional therapies administered via the nebulization route for use in the emergency department (ED).

SUMMARY

Although traditional routes of medication administration (eg, intravenous) have been the mainstay of administration modalities for decades, these routes may not be appropriate for all patients. Nowhere is this more readily apparent than in the ED setting, where patients with a variety of presentations receive care. One unique route for medication administration that has increasingly gained popularity in the ED is that of aerosolized drug delivery. This route holds promise as direct delivery of medications to the site of action could yield a more rapid and effective therapeutic response while also minimizing systemic adverse effects by utilizing a fraction of the systemic dose. Medication administration via nebulization also provides an alternative that is conducive to rapid, less invasive access, which is advantageous in the emergent setting of the ED. This review is intended to analyze the existing literature regarding this route of administration, including the nuances that can impact drug efficacy, as well as the available literature regarding novel, noncommercial nebulized medication therapy given in the ED.

CONCLUSION

Multiple medications have been investigated for administration via this route, and when implementing any of these therapies several practical considerations must be taken into account, from medication preparation to administration, to ensure optimal efficacy while minimizing adverse effects. The pharmacist is an essential bedside team member in these scenarios to assist with navigating unique and complex nuances of this therapy as they develop.

Nebuliser therapy in critical care: The past, present and future

Nebulisers are devices that reduce a body of liquid into a fine aerosol suitable for inhalation. Utilising the efficiency of pulmonary drug absorption, they offer a safe and powerful modality for local and systemic drug delivery in the treatment of critical illness. In comparison to conventional jet (JN) and ultrasonic nebulisers (USN), the advent of vibrating mesh nebulisers (VMN) has significantly improved the therapeutic potential of modern devices. This review article aims to summarise the history and evolution of nebulisers from first inception through to the modern vibrating mesh technology. It provides an overview on the basic science of nebulisation and pulmonary drug delivery, and the current use of nebulised therapies in critical care.