{
  "abstract": "Situation The use of nebulisers to administer drugs via aerosol inhalation during mechanical ventilation is becoming common practice. It is estimated that 1 in 4 patients receive such treatments. 1 Due to high acuity of complex patients on Paediatric Intensive Care Units (PICU) there has been an increase in nebulised medicines, including off-label use through the ventilator e.g. tranexamic acid-pulmonary haemorrhage, milrinone-pulmonary hypertension.The PICU team, including pharmacists, should be aware of factors that influence aerosol delivery to the lungs during ventilation and relationship to drug, device, patient, ventilator circuit and settings.2 The vibrating-mesh nebulisers used in the ventilator are approved for licensed nebulised medication only.3 The PICU pharmacist reviews the evidence-base for nebulising medicines through the ventilator, producing dosing and administration guidance. During this, the Medical-Physic Department reported 2 ventilator failures within 2 weeks from nebulised medicine build-up on the expiratory valve diaphragm. Deposits on the diaphragm cause development of large leaks in the ventilatory circuit. The extent of the problem couldn’t be determined as often faulty ventilators are sent without the expiratory valve diaphragm.In June 2025 the PICU pharmacist sent a survey to Healthcare Professionals (HCPs) involved in recommending, prescribing, or administering of nebulised medication through the ventilator, to assess awareness of the administering nebulised medication process and the potential damage to the ventilators. There were 44 responses out of 168: 22 Nurses, 12 Physiotherapists, 10 Medical/Advanced Clinical Practitioners, 1 Pharmacist.95% of respondents were aware that nebulised medicines are deposited in the ventilator, with 59% aware how to reduce this happening. Lack of awareness (41%) of how to reduce this is reflected in practice e.g. bacterial/expiratory filters not used or not removed after nebulisation. Also, no bacterial/expiratory filters are available for the neonatal circuit, so the technique of ‘bagging’ is used.80% were aware that the medication deposits could damage the ventilator, with 69% knowing that medication deposits on the expiratory valve. 23% of the respondents were prescribers, of these only 50% would consider the impact on the ventilator before prescribing nebulised medication.Lessons Learnt The pharmacist plays a vital role in making sure all HCPs involved in recommending/prescribing or administering of nebulised medicines through the ventilator understands the process involved to make sure treatment is safe and effective. To prescribe nebulised medicines through the ventilator, consideration of benefits versus the risks of lack of evidence-based practice, off-label administration, HCP exposure to aerosol particles and the potential inadvertent patient harm due to damage to ventilator needs to be considered.The ventilator failures due to drug deposits and the survey highlighted that the nebulisation technique through the ventilator needs to be improved to ensure efficient, safe, feasible and reproducible drug delivery,2 this will happen with sourcing of a bacterial/expiratory filter for the neonatal circuit and development of a training programme.PICU pharmacists can contribute by educating the PICU team through teaching sessions and producing nebulised medication through the ventilator guidance, with information on prescribing and administration e.g. only use bacterial/expiratory filter during nebulisation with vibrating-mesh nebulisers.References Ehrmann S, Roche-Campo F, Bodet-Contentin L, et al. Aerosol therapy in intensive and intermediate care units: prospective observation of 2808 critically ill patients. Intensive Care Medicine 2015;42(2):192–201.Dugernier J, Ehrmann S, Sottiaux T, et al. Aerosol delivery during invasive mechanical ventilation: a systematic review. Critical Care 2017;21(1).Aerogen | Aerosol medication administration with Aerogen Solo [Internet]. www.aerogen.com. Available from: https://www.aerogen.com/products/aerogen-solo",
  "authors": [
    {
      "affiliations": [
        "Leeds Children’s Hospital, UK"
      ],
      "name": "Teresa Brooks"
    },
    {
      "affiliations": [
        "Leeds Children’s Hospital, UK"
      ],
      "name": "Ramesh Kumar"
    },
    {
      "affiliations": [
        "Leeds Children’s Hospital, UK"
      ],
      "name": "Sharon Coulson"
    },
    {
      "affiliations": [
        "Leeds Children’s Hospital, UK"
      ],
      "name": "Stephen Morris"
    }
  ],
  "title": "P59 Pharmacist’s role in preventing mechanical ventilator damage from nebulised medicines",
  "uid": "389b7616-68fd-5132-ab0a-ce99428a3fab"
}