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inhalation therapy during high peep ventilation

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Dear 99ers,

i was wondering, what your practice is regarding patients with obstructive lung pathology, for example atypic varicella pneumonia, who need inahalative therapy with nebulized Albuterol (Ventolin) and are ventilated with high peak pressures >30cmH2O and high peep around 8cmH2O?

My thesis is that every time one disconnects the patient from the ventilator to connect the nebulizer, one predisposes the patient for derecruitment of lung volume (atelectasis). My question is if this practice brings more harm then benefit for the patient?

I am wondering what others do regarding that matter. Does anyone use inline nebulizing systems, which allows the system (nebulizer) to stay in the ventilator circuit for as long as the patient is ventilated?

If so, what system are you using and are there any hot tips one should know using this systems?

Regards Norbert

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