EFFECT OF NEBULIZED COLISTIN ON THE VENTILATOR CIRCUIT: A PROSPECTIVE PILOT CASE-CONTROL STUDY FROM A SINGLE CANCER CENTER

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Iyad M Ghonimat
Lama H Nazer *
Flsteen Aqel
Mohammad K Mohammad
Feras I Hawari
Jennifer Le
(*) Corresponding Author:
Lama H Nazer | LNazer@KHCC.JO

Abstract

Nebulized colistin (NC) is used for the treatment of pneumonia due to multidrug-resistant Gram-negative bacteria. In this one-year case-control study, our objective was to evaluate the effect of NC on the ventilator circuit (VC) components. The case group consisted of 25 mechanically-ventilated patients who received NC, while the control group was 25 mechanically-ventilated patients who did not receive NC. Respiratory therapists inspected the VC every 4 hrs and whenever a ventilator alarm was reported. The VC component was changed if the alarm did not subside after necessary measures were performed. Patients from both groups were treated at the adult ICU in King Hussein Cancer Center (KHCC). In the case group, 22(88%) patients required changing at least one of the circuit components (flow sensor, exhalation membrane, or nebulizer kit). The median number of changes (range) per patient of the flow sensor, exhalation membrane, and nebulizer kit were: 2(1-3), 2(1-6), and 1(1-2), respectively. Large amounts of white crystals, which resembled the colistin powder, were reported on the replaced VC components. The flow sensor was changed in 2 control patients, but white crystals were absent. Crystals obtained from one case subject were confirmed to be colistin by chromatographic mass spectroscopy. Further studies are needed to evaluate the effect of crystal formation on the efficacy of NC and clinical outcomes.    


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Author Biographies

Iyad M Ghonimat, King Hussein Cancer Center

Respiratory Therapy Services

Lama H Nazer, King Hussein Cancer Center,

Department of Pharmacy,

Flsteen Aqel, King Hussein Cancer Center

Respiratory Therapy Services

Feras I Hawari, King Hussein Cancer Center

Pulmonary and critical care

Jennifer Le, University of California, San Diego ,

Skaggs School of Pharmacy and Pharmaceutical Sciences

References

1. Michalopoulos A, Kasiakou SK, Mastora Z, Rellos K, Kapaskelis AM, Falagas ME. Aerosolized colistin for the treatment of nosocomial pneumonia due to multidrug resistant Gram-negative bacteria in patients without cystic fibrosis. Crit Care 2005;9:R53-9.
2. Michalopoulos A, Fotakis D, Virtzili S, Vletsas C, Raftopoulou S, Mastora Z, Falagas ME. Aerosolized colistin as adjunctive treatment of ventilator-associated pneumonia due to multidrug-resistant Gram-negative bacteria: a prospective study. Respir Med 2008;102:407-12.
3. Korbilla IP, Michalopoulos A, Rafailidis PI, et al. Inhaled colistin as adjunctive therapy to intravenous colistin for the treatment of microbiologically documented ventilator-associated pneumonia: a comparative cohort study. Clin Microbiol Infect 2010; 16:1230-6.
4. Naesens R, Vlieghe E, Verbrugghe W, et al. A retrospective observational study on the efficacy of colistin by inhalation as compared to parenteral administration for the treatment of nosocomial pneumonia associated with multidrug-resistant pseudomonas aeruginosa. BMC infect Dis 2011; 11:317.
5. Rattanaumpawan P, Lorsutthitham J, Ungprasert P, et al. Randomized controlled trial of nebulized colistimethate sodium as adjunctive therapy of ventilator-associated pneumonia caused by Gram-negative bacteria. J Antimicrob Chemother 2010; 65:2645-9.
6. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit care Med 2005; 17:388-416.
7. Le J, Ashley ED, Neuhauser MM, et al. Consensus summary of aerosolized antimicrobial agents: application of guideline criteria. Insights from the Society of Infectious Diseases Pharmacists. Pharmacotherapy 2010; 30:532-84.
8. Ghonimat I, Nazer, L, Aqel F, et al. Ventilator circuit obstruction associated with aerosolized colistin. Crit Care Med 2012;40 (Suppl 1):abstract #1188.
9. Hawari FI, Al Najjar TI, Zaru L, et al. The effect of implementing high-intensity intensive care unit staffing model in outcome of critically ill oncology patients. Crit Care Med 2009; 37(6):1967-71.