The number of pediatric and adult patients requiring tracheostomy has increased. Many of them require aerosol therapy as part of their treatment. Practitioners have little guidance on how to optimize drug delivery in this population. The following is a report of a workshop dedicated to review the current status of aerosol delivery to spontaneously breathing tracheostomized patients and to provide practice recommendations.
Get full access to this article
View all access options for this article.
References
1.
ShahRK, LanderL, BerryJG, NussenbaumB, MeratiA, and RobersonDW: Tracheotomy outcomes and complications: A national perspective. Laryngoscope. 2012; 122:25–29.
2.
LewisCW, CarronJD, PerkinsJA, SieKC, and FeudtnerC: Tracheotomy in pediatric patients: A national perspective. Arch Otolaryngol Head Neck Surg. 2003; 129:523–529.
3.
TatlaTS, and FitzgeraldCE: Care of patients with tracheostomies, T-Tubes and other airway devices. In: SandhuGS, and Reza NouraeiSA, (eds). Laryngeal and Tracheobronchial Stenosis. 2015. Plural Publishing, San Diego, CA. Pgs 151–194.
4.
TrachselD, and HammerJ: Indications for tracheostomy in children. Paediatr Respir Rev. 2006; 7:162–168.
5.
ShermanJM, DavisS, Albamonte-PetrickS, ChatburnRL, FittonC, GreenC, et al.: Care of the child with a chronic tracheostomy. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med. 2000; 161:297–308.
6.
AmiravI, and NewhouseMT: Aerosol therapy in tracheotomized children: Time for guidelines!. Respir Care. 2012; 57:1350.
7.
BaranD, DachyA, and KlasterskyJ: Concentration of gentamicin in bronchial secretions of children with cystic fibrosis of tracheostomy. (Comparison between the intramuscular route, the endotracheal instillation and aerosolization). Int J Clin Pharmacol Biopharm. 1975; 12:336–341.
8.
O'CallaghanC, DrydenS, CertDN, and GibbinK: Asthma therapy and a tracheostomy. J Laryngol Otol. 1989; 103:427–428.
9.
SubhedarNV, DoyleC, and ShawNJ: Administration of inhaled medication via a tracheostomy in infants with chronic lung disease of prematurity. Pediatr Rehabil. 1999; 3:41–42.
10.
MonksfieldP: Modification of a spacer device for paediatric tracheostomy. Clin Otolaryngol. 2008; 33:193–194.
11.
WebberPA, and BrownAR: The use of a conical spacer after laryngectomy. Br Med J (Clin Res Ed), 1984; 288:1537.
12.
NakhlaV: A homemade modification of a spacer device for delivery of bronchodilator or steroid therapy in patients with tracheostomies. J Laryngol Otol. 1997; 111:363–365.
13.
MirzaS, HopkinsonL, MalikTH, and WillattDJ: The use of inhalers in patients with tracheal stomas or tracheostomy tubes. J Laryngol Otol. 1999; 113:762–764.
14.
MeekerDP, and StelmachK: Modification of the spacer device. Chest. 1992; 102:1243–1244.
15.
García PachónE, CasanP, and SanchísJ: [Bronchodilators through tracheostomy]. Med Clin (Barc), 1992; 99:396–397. [Article in Spanish].
16.
NewhouseMT: Hemoptysis due to MDI therapy in a patient with permanent tracheostomy: Treatment with mask AeroChamber. Chest. 1999; 115:279–282.
17.
NandapalanV, CurreyM, and JonesTM: A modified spacer device for inhalational drug therapy for chronic bronchitis/asthma in laryngectomised patients. Clin Otolaryngol. 2000; 25:118–119.
18.
JohnsonDC: Interfaces to connect the HandiHaler and Aerolizer powder inhalers to a tracheostomy tube. Respir Care. 2007; 52:166–170.
19.
PitanceL, ReychlerG, VecellioL, LealT, ReychlerH, and LiistroG: Influence of tracheostomy on lung deposition in spontaneously breathing patients. J Aerosol Med Pulm Drug Deliv. 2016; 29:454–460.
20.
PiccuitoCM, and HessDR: Albuterol delivery via tracheostomy tube. Respir Care. 2005; 50:1071–1076.
21.
AriA, HarwoodRJ, SheardMM, and FinkJB: An in vitro evaluation of aerosol delivery through tracheostomy and endotracheal tubes using different interfaces. Respir Care. 2012; 57:1066–1070.
22.
BerlinskiA, and ChavezA: Albuterol delivery via metered dose inhaler in a spontaneously breathing pediatric tracheostomy model. Pediatr Pulmonol. 2013; 48:1026–1034.
23.
PitanceL, VecellioL, DelvalG, ReychlerG, ReychlerH, and LiistroG: Aerosol delivery through tracheostomy tubes: An in vitro study. J Aerosol Med Pulm Drug Deliv. 2013; 26:76–83.
24.
BerlinskiA: Nebulized albuterol delivery in a model of spontaneously breathing children with tracheostomy. Respir Care. 2013; 58:2076–2086.
25.
AlhamadBR, FinkJB, HarwoodRJ, SheardMM, and AriA: Effect of aerosol devices and administration techniques on drug delivery in a simulated spontaneously breathing pediatric tracheostomy model. Respir Care. 2015; 60:1026–1032.
26.
BugisAA, SheardMM, FinkJB, HarwoodRJ, and AriA: Comparison of aerosol delivery by face mask and tracheostomy collar. Respir Care. 2015; 60:1220–1226.
27.
CooperB, and BerlinskiA: Albuterol delivery via facial and tracheostomy route in a model of a spontaneously breathing child. Respir Care. 2015; 60:1749–1758.
28.
Ari AriA, HarwoodR, SheardM, AlquaimiMM, AlhamadB, and FinkJB: Quantifying aerosol delivery in simulated spontaneously breathing patients with tracheostomy using different humidification systems with or without exhaled humidity. Respir Care. 2016; 61:600–606.
29.
BerlinskiA, and CooperB: Oronasal and tracheostomy delivery of soft mist and pressurized metered-dose inhalers with valved holding chamber. Respir Care, 2016; 61:913–919.
30.
WeeW, TaverniniS, MartinAR, AmiravI, MajaesicC, and FinlayWH: Dry power inhaler delivery of tobramycin in in vitro models of tracheostomized children. J Aerosol Med Pulm Drug Deliv. 2016; [Epub ahead of print]. DOI: 10.1089/jamp.2016.1309.
YuM: Tracheostomy patients on the ward: Multiple benefits from a multidisciplinary team?. Critical Care. 2010; 14:109–102.
33.
EpsteinSK: Anatomy and physiology of tracheostomy. Respir Care. 2005; 50:476–482.
34.
JarrettWA, RibesJ, and ManaligodJM: Biofilm formation on tracheostomy tubes. Ear Nose Throat J. 2002; 81:659–661.
35.
CarronJD, DerkayCS, StropeGL, et al.: Pediatric tracheostomies: Changing indications and outcomes. Laryngoscope. 2000; 110:1099–1104.
36.
LawrasonA, and KavanaghK: Pediatric tracheostomy: Are the indications changing?. Int J Pediatr Otorhinol. 2013; 77:922–925.
37.
Perez-RuizE, CaroP, Perez-FriasJ, et al.: Paediatric patients with a tracheostomy: Multicentre epidemiological study. Eur Resp J. 2012; 40:1502–1507.
38.
WillisLD, and BerlinskiA: Survey of aerosol delivery techniques to spontaneously breathing tracheostomized children. Respir Care. 2012; 57:1234–1241.
39.
DolovichMB, and DhandR: Aerosol drug delivery: Developments in device design and clinical use. Lancet. 2011; 377:1032–1045.
40.
LaubeBL, JanssensHM, de JonghFH, DevadasonSG, DhandR, DiotP, EverardML, HorvathI, NavalesiP, VoshaarT, ChrystynH; European Respiratory Society; International Society for Aerosols in Medicine. What the pulmonary specialist should know about the new inhalation therapies. Eur Respir J. 2011; 37:1308–1331.
41.
RubinBK, and WilliamsRW: Emerging aerosol drug delivery strategies: From bench to clinic. Adv Drug Deliv Rev. 2014; 75:141–148.
42.
MyersTR: Year in review 2014: Aerosol delivery devices. Respir Care. 2015; 60:1190–1196.
43.
FinkJB, DhandR, GrychowskiJ, et al.: Reconciling in vitro and in vivo measurements of aerosol delivery from a metered-dose inhaler during mechanical ventilation and defining efficiency-enhancing factors. Am J Respir Crit Care Med. 1999; 159:63–68.
44.
FinkJ, and AriA: Aerosol delivery to intubated patients. Expert Opin Drug Deliv. 2013; 10:1077–1093.
45.
FinkJB, DequinPF, MercierE, et al.: Nebulizer efficiency measured in vitro agrees with sputum concentration of amikacin in patient on mechanical ventilation. Respir Drug Delivery IX, 2004; 2:337–340.
46.
ZuurJK, MullerSH, de JonghFH, vanZN, and HilgersFJ: The physiological rationale of heat and moisture exchangers in post-laryngectomy pulmonary rehabilitation: A review. Eur Arch Otorhinolaryngol. 2006; 263:1–8.
47.
MauriziM, PaludettiG, AlmadoriG, OttavianiF, and TodiscoT: Mucociliary clearance and mucosal surface characteristics before and after total laryngectomy. Acta Otolaryngol. 1986; 102:136–1345.
48.
HessMM, SchwenkRA, FrankW, and LoddenkemperR: Pulmonary function after total laryngectomy. Laryngoscope. 1999; 109:988–994.
49.
BarnesKL, CliffordR, HolgateST, MurphyD, ComberP, and BellE: Bacterial contamination of home nebuliser. Br Med J (Clin Res Ed), 1987; 295:812.
50.
CravenDE, LichtenbergDA, GoularteTA, MakeBJ, and McCabeWR: Contaminated medication nebulizers in mechanical ventilator circuits. Source of bacterial aerosols. Am J Med, 1984; 77:834–838.
51.
VassalS, TaammaR, MartyN, SardetA, d'athisP, BremontF, et al.: Microbiologic contamination study of nebulizers after aerosol therapy in patients with cystic fibrosis. Am J Infect Control, 2000; 28:347–351.
52.
SaimanL, SiegelJD, LiPumaJJ, BrownRF, BrysonEA, ChambersMJ, DownerVS, FliegeJ, HazleLA, JainM, MarshallBC, O'MalleyC, PatteeSR, Potter-BynoeG, ReidS, RobinsonKA, SabadosaKA, SchmidtHJ, TullisE, WebberJ, and WeberDJ: Cystic fibrous foundation; society for healthcare epidemiology of America. Infection prevention and control guideline for cystic fibrosis: 2013 update. Infect Control Hosp Epidemiol. 2014; 35Suppl 1:S1–S67.