A Scandinavian survey of drug administration through inhalation, suctioning and recruitment maneuvers in mechanically ventilated patients

Background: The aim was to describe current practices for drug administration through inhalation, endotracheal suctioning and lung recruitment maneuvers in mechanically ventilated patients in Scandinavian intensive care units (ICUs). Methods: We invited 161 ICUs to participate in a web-based survey regarding (1) their routine standards and (2) current treatment of ventilated patients during the past 24 h. In order to characterize the patients, the lowest PaO₂ with the corresponding highest FiO₂, and the highest PaO₂ with the corresponding lowest FiO₂ during the 24-h study period were recorded. Results: Eighty-seven ICUs answered and reported 186 patients. Positive end-expiratory pressure (PEEP) levels (cmH₂O) were 5-9 in 65% and >10 in 31% of the patients. Forty percent of the patients had heated humidification and 50% received inhalation of drugs. Endotracheal suctioning was performed >7 times during the study period in 40% of the patients, of which 23% had closed suction systems. Twenty percent of the patients underwent recruitment maneuvers. The most common recruitment maneuver was to increase PEEP and gradually increase the inspiratory pressure. Twenty-six percent of the calculated PaO₂-FiO₂ ratios varied >13 kPa for the same patient. Conclusion: Frequent use of drug administration through inhalation and endotracheal suctioning predispose to derecruitment of the lungs, possibly resulting in the large variations in PaO₂- FiO₂ ratios observed during the 24-h study period. Recruitment maneuvers were performed only in one-fifth of the patients during the day of the survey.