(1000) Impact of Inhaled Nebulized Therapies on Duration of Mechanical Ventilation in the Critically Ill

Introduction: Inhaled nebulizer solutions are routinely administered in the ICU to prevent mucus accumulation, atelectasis, and ventilator associated pneumonia (VAP). The impact of inhaled nebulized therapies on clinical outcomes has not been shown and overutilization of nebulized solutions may increase the risk of adverse effects and costs. The goal of our study is to compare clinical outcomes of critically ill adults who received a nebulizer solution versus patients who did not receive a nebulizer solution.

Methods: A single center, retrospective cohort study at a large academic medical center was performed on adult MV ICU patients from January 2022 to June 2022. Patients administered at least one nebulizer treatment during MV were placed in the treatment group. Patients with a history of COPD, asthma, cystic fibrosis, and lung transplant were excluded. The primary outcome was duration of MV. Secondary outcomes included ICU mortality, ICU LOS, hospital LOS, and the incidence of VAP and atelectasis.

Results: Of the 169 patients included in the analysis, 93 received a nebulized solution and 76 did not receive a nebulized solution during MV. Patients were predominantly male (52.7%) and Caucasian (60.4%). The nebulized solution group had a significantly shorter difference in duration of MV in comparison to patients who did not receive a nebulized solution (12.5 days vs. 2.5 days; p< 0.001). There was a statistically significant decrease between the nebulized and non-nebulized groups in ICU LOS (21.2 days vs. 4.9 days, p< 0.001) and hospital LOS (46.0 days vs. 12.8 days, p< 0.001). Also, incidence of VAP occurred more in the nebulizer group than the non-nebulizer group (26.9% vs. 1.3%; p< 0.001). There were no statistically significant differences in incidence of atelectasis or ICU mortality.

Conclusions: Our study found a longer duration of MV in patients receiving nebulized therapies compared to those that did not. Nebulizer treatments may lead to increased medication costs and utilization of resources while providing limited benefit. Our results support a more judicious use of nebulized therapies in the ICU, although further prospective studies are needed to confirm these findings.