目的:确定有创机械通气患者通过加压吸入器对支气管扩张剂的给药特征和连接方法。
方法:在PRISMA范围审查之后进行了范围审查,使用PubMed,EmbaseElsevier,科克伦图书馆,和Lilacs数据库没有语言限制,到2023年7月。合格来源包括评论和共识(基于临床研究),实验和观察性研究涉及入住重症监护病房并接受有创机械通气的成年患者,不管潜在的条件是什么,使用加压吸入器中的支气管扩张剂药物。有关吸入技术的信息,加压吸入器与回路的连接模式,患者护理由2名研究人员独立收集,差异由第三位审阅者解决。在同一装置中涉及支气管扩张剂与其他药理学类别组合的研究,以及包含临床前研究的评论,被排除在外。
结果:总计,包括23种出版物,包括19项临床试验和4项非随机实验研究。沙丁胺醇(沙丁胺醇)是大多数文章中研究的支气管扩张剂(n=18),和间隔装置是最常用的连接加压吸入器的回路(n=15),后跟一个在线适配器(n=3),和直接作用装置无室(n=3)。关于加压吸入器在回路中的位置,18项研究将其定位在吸气肢体中,和19项研究使射流致动与吸气阶段的开始同步。在每次致动之前,对加压吸入器进行搅拌,启动之间的等待时间,给药前气道抽吸,和半卧位患者定位是研究中最常用的测量指标.
结论:这篇综述提供了与机械通气患者吸入技术相关的方面的见解,以及在这种情况下,关于支气管扩张剂给药的最普遍发现和现有知识空白。证据表明需要对这一主题进行进一步研究。
OBJECTIVE: To identify the administration characteristics and connection methods of bronchodilators by pressurized inhalers to the ventilatory circuit of patients under invasive mechanical ventilation.
METHODS: A scope review was conducted following the PRISMA for Scoping Review, using the PubMed, Embase Elsevier, Cochrane Library, and Lilacs databases without language restrictions, up to July 2023. Eligible sources included reviews and consensuses (based on clinical studies), experimental and observational studies involving adult patients admitted to the intensive care unit and undergoing invasive mechanical ventilation, regardless of the underlying condition, who used bronchodilator drugs contained in pressurized inhalers. Information regarding inhalation technique, pressurized inhalers connection mode to the circuit, and patient care were collected by 2 researchers independently, with discrepancies resolved by a third reviewer. Studies involving bronchodilators combined with other pharmacological classes in the same device, as well as reviews containing preclinical studies, were excluded.
RESULTS: In total, 23 publications were included, comprising 19 clinical trials and 4 non-randomized experimental studies. Salbutamol (albuterol) was the bronchodilator of study in the majority of the articles (n=18), and the spacer device was the most commonly used to connect the pressurized inhaler to the circuit (n=15), followed by an in-line adapter (n=3), and a direct-acting device without chamber (n=3). Concerning the pressurized inhaler placement in the circuit, 18 studies positioned it in the inspiratory limb, and 19 studies synchronized the jet actuation with the start of the inspiratory phase. Agitation of the pressurized inhaler before each actuation, waiting time between actuations, airway suction before administration, and semi-recumbent patient positioning were the most commonly described measures across the studies.
CONCLUSIONS: This review provided insights into the aspects related to inhalation technique in mechanically ventilated patients, as well as the most prevalent findings and the existing gaps in knowledge regarding bronchodilator administration in this context. The evidence indicates the need for further research on this subject.