Systematic review of aerosol therapy in invasive mechanical ventilation: Effective device positioning and the role of nurse.

INTRODUCTION

Aerosol therapy during invasive mechanical ventilation is a common practice in intensive care units, however, its effectiveness is highly dependent on technical factors. Variability in device positioning and nursing technique produces substantial differences between the nominal dose and the fraction of drug that reaches the lungs, underscoring the need for standardized placement to enhance both safety and therapeutic efficiency.

OBJECTIVE

To examine recent scientific evidence to determine the optimal positioning of aerosol delivery devices within the ventilator circuit, thereby guiding nursing practice toward standardized, evidence-informed procedures.

METHODOLOGY: Systematized review (2018-2025) conducted in PubMed, BVSalud, and complementary academic search engines. MeSH, DeCS, and free-text terms related to aerosol therapy and mechanical ventilation were used. The PIO framework was applied following PRISMA guidelines and GRADE assessment. From 165 initial records, eight original studies were included.

RESULTS

Vibrating mesh nebulizers demonstrated greater efficiency when positioned on the inspiratory limb, either near the Y-piece (10-15 cm) or at the humidifier inlet. Jet nebulizers showed optimal placement varying according to the device type (continuous, breath-actuated, or synchronized), although their overall performance was inferior to that of vibrating mesh nebulizers. Metered-dose inhalers were most effective when positioned on the inspiratory limb before the Y-piece, particularly when used with a spacer.

CONCLUSIONS

The available evidence suggests that device positioning influences the efficiency of aerosol therapy during invasive mechanical ventilation. Vibrating mesh nebulizers and properly positioned inhalers may improve pulmonary drug delivery; however, the overall certainty of the evidence remains low.