Jet or Vibrating Mesh Nebulisation for Secretion Management in ICU

Critically unwell patients in Intensive Care have a decreased ability to effectively clear secretions. High secretion load is a major risk factor in the failure of tracheal extubation failure and the requirement for reintubation. Extubation failure is a predictor of poor outcome independent of the severity of the underlying illness. Nebulisation of isotonic saline can be employed to manage secretions by reducing the secretion viscosity and facilitating clearance of respiratory sections during tracheal suction.Standard jet nebulisers have been the mainstay of respiratory section management therapy in critical care since the early 1990s. A more recent development has been the vibrating mesh nebuliser. There is evidence of improved humidification and reduced water particle size and theoretically better transfer to the distal airways.

Inclusion Criteria:Patient aged 18-80 years at time of recruitment to studyVentilated via an endotracheal tube or tracheostomy with an HME filter in the circuitSecretion load defined as patient requiring suctioning at least 2 times in the 6 hours prior to recruitmentSputum viscosity with grades 1 to 3 pourability in the Qualitative Sputum Assessment toolNot yet received saline nebulisation in the 6 hours prior to recruitmentLikely to be ventilated via an endotracheal tube or tracheostomy for at least 3 days in the opinion of the treating clinicianExclusion Criteria:PregnancyPulmonary embolusHeart Failure (NYHA Grade III/IV)Clinical evidence of frank pulmonary oedemaCardiovascular instability (systolic BP ≤75 or heart rate ≥140)