TABLE 3.

Steps to optimize inhaled drug delivery during mechanical ventilation

Step	Instruction(s)
1	Review inhaled-antibiotic order and assess need for pretreatment bronchodilator
2	Clear excess secretions from airway, if present
3	Load drug in nebulizer to manufacturer-recommended specifications
4	Position nebulizer on inspiratory line 10–15 cm from Y piece
5	Use continuous flow during nebulizer operation and remove heat-moisture exchanger from circuit
6	Set gas flow to nebulizer according to the manufacturer's specifications, and adjust ventilator limits to compensate for added flow
7	Run nebulizer until it begins to sputter
8	Remove nebulizer from circuit, rinse with sterile water, and run dry
9	Reconnect heat-moisture exchanger, and return ventilator to previous settings
10	Monitor patient for adverse events
11	Assess outcome of treatment