Effect of On-Demand vs Routine Nebulization of Acetylcysteine With Salbutamol on Ventilator-Free Days in Intensive Care Unit Patients Receiving Invasive Ventilation: A Randomized Clinical Trial

JAMA : the Journal of the American Medical Association
David M P van MeenenFrederique Paulus

Abstract

It remains uncertain whether nebulization of mucolytics with bronchodilators should be applied for clinical indication or preventively in intensive care unit (ICU) patients receiving invasive ventilation. To determine if a strategy that uses nebulization for clinical indication (on-demand) is noninferior to one that uses preventive (routine) nebulization. Randomized clinical trial enrolling adult patients expected to need invasive ventilation for more than 24 hours at 7 ICUs in the Netherlands. On-demand nebulization of acetylcysteine or salbutamol (based on strict clinical indications, n = 471) or routine nebulization of acetylcysteine with salbutamol (every 6 hours until end of invasive ventilation, n = 473). The primary outcome was the number of ventilator-free days at day 28, with a noninferiority margin for a difference between groups of -0.5 days. Secondary outcomes included length of stay, mortality rates, occurrence of pulmonary complications, and adverse events. Nine hundred twenty-two patients (34% women; median age, 66 (interquartile range [IQR], 54-75 years) were enrolled and completed follow-up. At 28 days, patients in the on-demand group had a median 21 (IQR, 0-26) ventilator-free days, and patients in the routine...Continue Reading

Citations

May 10, 2018·Trials·Anna Geke AlgeraUNKNOWN RELAx Investigators and the PROVE Network Investigators
Dec 10, 2020·JAMA : the Journal of the American Medical Association·UNKNOWN Writing Committee and Steering Committee for the RELAx Collaborative GroupFrederique Paulus
Aug 8, 2021·Journal of Clinical Medicine·Willemke StilmaFrederique Paulus
Oct 29, 2021·Anesthesiology·David LagierMarcos F Vidal Melo

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