00:00:00 intro
00:08:30 VAP
00:09:30 SENAME global survey
00:11:00 tobramycin
00:11:40 colistin
00:21:00 events ettins
00:24:00 conclusion, discusion
The meeting featured a presentation by Professor Jordi Rello on the use of aerosolized antibiotics in treating respiratory infections, with a focus on ventilator-associated pneumonia and the potential for reducing nephrotoxicity.,also covered the use of aerosolized antibiotics as a strategy to combat carbapenem resistance, the importance of a strict delivery protocol, and the need for further investigation into how these antibiotics are delivered and absorbed.I
Dr. introduces the distinguished Professor Jordi Rello from Spain, who is an expert in critical care medicine. Dr. provides an overview of Professor Rello's impressive credentials, Professor Rello briefly responds, thanking Dr. for the introduction. The discussion then appears to transition, but the content is unclear due to the language barrier.
Nebulizers for Aerosolized Antibiotic Therapy
Jordi presents a summary of different nebulizers used for aerosolized antibiotic therapy, particularly for ventilator-associated pneumonia. He discusses the potential indications, including prophylaxis, treatment of multidrug-resistant organisms, and prevention of pneumonia in colonized patients. The presentation highlights the heterogeneity in the use of aerosolized antibiotics across different regions and agents. Jordi emphasizes that findings with one antibiotic cannot be extrapolated to others. While some systematic reviews suggest a small advantage of combining aerosolized and systemic therapy, the evidence from randomized trials is limited. Aerosolized aminoglycosides may reduce nephrotoxicity compared to systemic administration, making it a potential option for patients at risk of acute kidney injury.
Aerosolized Antibiotics and Respiratory Infections
Jordi discussed the use of aerosolized antibiotics in treating respiratory infections, highlighting the importance of dosage and concentration. He noted that higher doses are often used for ventilator-associated pneumonia and that the concentration in the epithelial lining fluid is crucial. Jordi also mentioned a survey conducted with the European Society of Clinical Microbiology and Infectious Diseases, which showed a trend towards higher doses when treating pneumonia. He emphasized the need for a fivefold concentration of the minimal inhibitory concentration and the importance of considering extrapulmonary deposition when aerosolizing. Jordi also discussed a trial from 20 years ago that used a high dose of nebulized cholestine, which showed promising results.
Aerosolized Antibiotics for Carbapenem Resistance
Jordi discussed the use of aerosolized antibiotics as an innovative strategy to combat increasing carbapenem resistance in microbial infections. He emphasized the importance of a strict delivery protocol with high dose nebulized colistin for managing episodes of persistent organisms. Jordi also highlighted the need for further investigation into how aerosolized antibiotics are delivered, absorbed into the bloodstream, and impact serum profiles. He concluded by recommending the guidelines and consensus statement on nebulizing antimicrobial agents in mechanically ventilated patients. Dr. then opened the floor for questions and discussion.
Nebulized Antibiotics and High Flow Therapy
In the meeting, Dr. and Jordi discussed the use of nebulized antibiotics in patients with high flow nasal therapy. Jordi recommended a consensus paper from two years ago that standardized the conditions for using high flow nasal therapy. He also discussed the use of various antibiotics, including Colistin, Amikacin, and Aztreonam, and their potential benefits and drawbacks. Jordi also mentioned the use of nebulized Prostaglandin formulations for pulmonary arterial hypertension and the use of steroids in certain situations. He advised against using jet nebulizers for mechanical ventilated patients due to their inefficiency in such cases.
Audience members to read the guidelines on nebulizing antimicrobials published in Clinical Microbiology and Infection journal.
Audience members to review the consensus position statement on key conceptual considerations for nebulization of antimicrobial agents in mechanically ventilated patients.
Clinicians to use the specific formulation of tobramycin designed for airway administration rather than diluting the systemic formulation in saline.
Clinicians to consider switching from systemic to aerosolized aminoglycosides in patients with impaired renal clearance or nephrotoxicity.
Clinicians to avoid using nebulized N-acetylcysteine in mechanically ventilated patients due to the risk of inducing severe bronchospasm.
Clinicians to use mesh membrane nebulizers instead of jet nebulizers for treating pneumonia in mechanically ventilated patients.
