As the Society of Critical Care Medicine (SCCM) President, I am frequently invited to speak at other critical care conferences around the globe, providing me with the opportunity to hear other presentations and to network. At one such recent conference, an international speaker was addressing the state of the science regarding aerosolized medications for patients who are mechanically ventilated. Certainly choice of aerosol device, placement in the ventilator circuit, and administrative techniques are important, but they often are not considered by the intensivist who relies on the respiratory therapist to manage those concerns. Most of the audience at this conference, however, did not have such support, and so these topics generated the majority of the participants’ questions. One attendee asked if the speaker would be willing to assist in developing some protocols for commonly used ventilators and aerosol devices. The speaker said he was helping a group in another country with that and would be glad to work with them as well.
This international sharing of critical care clinicians is a core value that is repeatedly demonstrated, but admittedly still makes me smile. That speaker is a respiratory therapist and a recognized expert extending his efforts for critically ill patients anywhere and everywhere. Like many of us,
he is a member of numerous organizations, such as the American Association of Aerosol Research. I have since learned that he is also a member of SCCM (though not formally representing SCCM at this meeting).
The lecture included discussion of the influence of ventilator parameters on delivered aerosol dose, both a refresher and an update for most of us. This lecture was excellent but spurred me to return to the literature to review some of the research details. For instance, inspiratory time influences drug deposition in nebulizers but not pressurized metered-dose inhalers. Ventilator high inspiratory flow rates can decrease aerosol deposition.
Spontaneous mode ventilation can increase the drug deposition by 30% over the same tidal volume delivered by controlled breaths. In fact, many of the variables alone can influence the deposition by large amounts. The take-home advice for my practice: when a patient is not responding as expected, take a more thorough look at the parameters that may be influencing drug deposition. Coincidently, this scenario occurred with a patient the very next week.
This is but one example of the benefits of conference attendance. Certainly we select our most pertinent topics among the many offerings, and those are a key reason for attending. However, invariably we end up attending lectures on topics we might otherwise have skipped over
in a journal – like this lecture on aerosol deposition in mechanically ventilated patients, which has now improved my practice. But this conference experience also reaffirmed the value of the team in critical care and the generosity of SCCM members. As you read Critical Connections and catch
up on some of the Congress content, see what can enhance the care you deliver. But also consider attending a conference – like the Congress in San Francisco next January!