Publication:
Effect of on-demand vs routine nebulization of acetylcysteine with salbutamol on ventilator-free days in intensive care unit patients receiving invasive ventilation: A randomized clinical trial

3

Issued Date

2018-03-13

Resource Type

Conference Paper

ISSN

15383598
00987484

DOI

10.1001/jama.2018.0949

Other identifier(s)

2-s2.0-85043571032

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

JAMA - Journal of the American Medical Association. Vol.319, No.10 (2018), 993-1001

Suggested Citation

David M.P. Van Meenen, Sophia M. Van Der Hoeven, Jan M. Binnekade, Corianne A.J.M. De Borgie, Maruschka P. Merkus, Frank H. Bosch, Henrik Endeman, Jasper J. Haringman, Nardo J.M. Van Der Meer, Hazra S. Moeniralam, Mathilde Slabbekoorn, Marcella C.A. Muller, Willemke Stilma, Bart Van Silfhout, Ary Serpa Neto, Hans F.M. Ter Haar, Jan Van Vliet, Jan Willem Wijnhoven, Janneke Horn, Nicole P. Juffermans, Paolo Pelosi, Marcelo Gama De Abreu, Marcus J. Schultz, Frederique Paulus Effect of on-demand vs routine nebulization of acetylcysteine with salbutamol on ventilator-free days in intensive care unit patients receiving invasive ventilation: A randomized clinical trial. JAMA - Journal of the American Medical Association. Vol.319, No.10 (2018), 993-1001. doi:10.1001/jama.2018.0949 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/46829

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Title

Effect of on-demand vs routine nebulization of acetylcysteine with salbutamol on ventilator-free days in intensive care unit patients receiving invasive ventilation: A randomized clinical trial

Author(s)

David M.P. Van Meenen
 Sophia M. Van Der Hoeven
 Jan M. Binnekade
 Corianne A.J.M. De Borgie
 Maruschka P. Merkus
 Frank H. Bosch
 Henrik Endeman
 Jasper J. Haringman
 Nardo J.M. Van Der Meer
 Hazra S. Moeniralam
 Mathilde Slabbekoorn
 Marcella C.A. Muller
 Willemke Stilma
 Bart Van Silfhout
 Ary Serpa Neto
 Hans F.M. Ter Haar
 Jan Van Vliet
 Jan Willem Wijnhoven
 Janneke Horn
 Nicole P. Juffermans
 Paolo Pelosi
 Marcelo Gama De Abreu
 Marcus J. Schultz
 Frederique Paulus

Other Contributor(s)

Ospedale Policlinico San Martino
 Amphia Hospital
 St. Antonius Ziekenhuis
 Dresden University Faculty of Medicine and University Hospital Carl Gustav Carus
 Our Lady Hospital - Amsterdam
 Hospital Israelita Albert Einstein
 Mahidol University
 Isala Clinics
 Amsterdam UMC - University of Amsterdam
 Haaglanden Medical Center

Abstract

© 2018 American Medical Association. All rights reserved. IMPORTANCE: It remains uncertain whether nebulization of mucolytics with bronchodilators should be applied for clinical indication or preventively in intensive care unit (ICU) patients receiving invasive ventilation. OBJECTIVE: To determine if a strategy that uses nebulization for clinical indication (on-demand) is noninferior to one that uses preventive (routine) nebulization. DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial enrolling adult patients expected to need invasive ventilation for more than 24 hours at 7 ICUs in the Netherlands. INTERVENTIONS: On-demand nebulization of acetylcysteine or salbutamol (based on strict clinical indications, n = 471) or routine nebulization of acetylcysteine with salbutamol (every 6 hours until end of invasive ventilation, n = 473). MAIN OUTCOMES AND MEASURES: The primary outcome was the number of ventilator-free days at day 28, with a noninferiority margin for a difference between groups of -0.5 days. Secondary outcomes included length of stay, mortality rates, occurrence of pulmonary complications, and adverse events. RESULTS: Nine hundred twenty-two patients (34% women; median age, 66 (interquartile range [IQR], 54-75 years) were enrolled and completed follow-up. At 28 days, patients in the on-demand group had a median 21 (IQR, 0-26) ventilator-free days, and patients in the routine group had a median 20 (IQR, 0-26) ventilator-free days (1-sided 95% CI, -0.00003 to ∞). There was no significant difference in length of stay or mortality, or in the proportion of patients developing pulmonary complications, between the 2 groups. Adverse events (13.8% vs 29.3%; difference, -15.5% [95% CI, -20.7% to -10.3%]; P <.001) were more frequent with routine nebulization and mainly related to tachyarrhythmia (12.5% vs 25.9%; difference, -13.4% [95% CI, -18.4% to -8.4%]; P <.001) and agitation (0.2% vs 4.3%; difference, -4.1% [95% CI, -5.9% to -2.2%]; P <.001). CONCLUSIONS AND RELEVANCE: Among ICU patients receiving invasive ventilation who were expected to not be extubated within 24 hours, on-demand compared with routine nebulization of acetylcysteine with salbutamol did not result in an inferior number of ventilator-free days. On-demand nebulization may be a reasonable alternative to routine nebulization.

Keyword(s)

Medicine

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https://repository.li.mahidol.ac.th/handle/123456789/46829

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Scopus 2018