Revista de medicina pulmonar

Effective secretolytic and bronchodilatativ strategies by prolonged weaning by COPD

M Lavae-Mokhtari, M Kindermann, A Akil, M Semik, St Fischer and N Dickgreber

A metaanalyses of studies published in the 1990s calculated the incidence of VAP (ventilator-associated pneumonia), which is equivalent to 16.5 cases per 1,000 patient days. Attributable mortality due to VAP was estimated to be 20-40%, although the rang in different studies was very broad. Healthcare costs related to VAP seem to be remarkable in particular with regard to multidrug-resistant pathogens. VAP is an infection frequently caused by Pseudomonas aeruginosa, Haemophilus spp. and Klebsiella spp. or by Staphylococcus aureus. Anaerobes are a rare cause of VAP. Patients with COPD GOLD D and massive Emphysema, who undergo a Lung Volume Reduction Surgery by prolonged Weaning and long-tern treatment on intensive care units, need an intensive and efficient secrtlytic additionally to bronchoscopy by presenting bronchospasms at the same time. On our Respiratory Intensive Care Unit, we use a Dymedso Frequenzer with sound wave (45 Hz) from the company inspiration medical four times daily in combination with six times deeply bronchodilatativ Aeronep Inhalation from the company Aerogen to reach a 17% lung disposition in compared to 3% by conventional nebulizer. We optimize this by an LALMA/LABA fix combination (Glycopyrroniumbromid/Formoterol) via tracheal cannula from the company AstraZeneca with AEROSPHERE Delivery Technology. Active ingredient particles are connected on aerodynamic Phospholipid particles, which are a natural carrier substance and a component of lung surfactant. Previous studies with health persons could show lung disposition of 38%. The safety and efficiency were demonstrated in phase 3 study PINNACLE 1 and 2 and long-term data of safety and effectiveness in PINNACLE 3.