Table 3.

Practical strategies for aerosol drug delivery to intensive-care patients with COVID-19.

1. Do not use a jet nebulizer or pMDIs for aerosol delivery to ventilator-dependent patients with COVID-19 due to the breakage of the circuits for the placement of the device before aerosol therapy.

2. Use mesh nebulizers in critically ill patients with COVID-19 receiving ventilator support as they can stay in-line for up to 28 days, and reservoir design allows adding medication without requiring the ventilator circuit to be broken for aerosol drug delivery. Unlike jet nebulizer, the medication reservoir of mesh nebulizers is isolated from the breathing circuit that eliminates the nebulization of contaminated fluids.

3. Placing the mesh nebulizer prior to the humidifier can improve the efficiency of the treatment and further reduce retrograde contamination from the patient.

4. Attach a HEPA filter to the expiratory limb of the ventilator to reduce secondhand aerosol exposure and prevent the transmission of infectious droplet nuclei through the ventilators.

5. Do not combine aerosol therapy with pulmonary clearance techniques such as chest physical therapy and suctioning.

6. Use in-line, or closed system suction catheters if the patient with COVID-19 is intubated and needs endotracheal suctioning during mechanical ventilation because they can be utilized up to 7 days without having to break the ventilator circuit.

7. Wear personal protective equipment, including an N95 respirator, goggles/face shield, double gloves, gown or apron if the gown is not fluid resistant.