Safety Considerations for Using Inhaled Vapors in IVAPS Mode
When using inhaled vapors in the IVAPS (Intelligent Volume-Assured Pressure Support) mode, maintaining a closed circuit system with a vibrating mesh nebulizer is essential to prevent transmission of respiratory infections and ensure effective medication delivery. 1
Nebulizer Selection and Circuit Integrity
- Vibrating mesh nebulizers (VMNs) are preferred in ventilated patients as they allow for medication addition without breaking the ventilator circuit, which is crucial for preventing transmission of infectious agents 1
- If a jet nebulizer (JN) must be used, a valved T-adapter should be incorporated in line with the ventilator circuit to maintain pressure and minimize aerosol escape 1
- Breaking the ventilator circuit to add medication or change nebulizers should be avoided as this generates potentially infectious aerosol from condensate 1
Infection Control Measures
- Use appropriate personal protective equipment (PPE), including N95 respirators rather than surgical masks when administering nebulized treatments, especially in patients with suspected respiratory infections 1
- For patients receiving mechanical ventilation with IVAPS, disposable nebulizers are recommended to reduce the risk of contamination 1
- After each use, rinse residual medication with sterile water, wipe the mouthpiece or face mask with an alcohol pad, and discard the nebulizer after 24 hours 1
Reducing Fugitive Aerosol Emissions
- VMNs combined with filtered mouthpieces generate the least amount of fugitive aerosol compared to continuous jet nebulizers 1
- When mouthpieces cannot be used due to physical or mental disabilities, use a fitted face mask with expiratory filters or a commercially available scavenger system 1
- Breath-actuated nebulizers further reduce fugitive emissions compared to constant-output nebulizers 1
- Patients should not remove the mouthpiece or face mask while the nebulizer is still running to prevent unnecessary aerosol release 1
Special Considerations for Tracheostomy Patients
- For spontaneously breathing patients with a tracheostomy, use a T-piece with an expiratory filter to deliver nebulized treatments 1
- Avoid using masks placed over tracheostomy tubes as they inadequately prevent aerosol escape into the environment 1
Medication Safety
- When using sympathomimetic medications like albuterol in IVAPS mode, monitor for cardiovascular effects, especially in patients with pre-existing cardiovascular disorders, diabetes mellitus, or hyperthyroidism 2
- Be aware that large doses of nebulized medications like albuterol may produce significant hypokalemia in some patients, which has potential for adverse cardiovascular effects 2
Patient Monitoring During IVAPS Therapy
- IVAPS mode has shown comparable efficacy to standard Spontaneous/Timed (S/T) modes in managing patients with hypercapnic respiratory failure 3, 4
- Monitor arterial blood gases to ensure effective ventilation, as IVAPS automatically adjusts pressure support to maintain consistent alveolar ventilation 4, 5
- IVAPS may provide better patient comfort and satisfaction compared to fixed-EPAP modalities, which could improve treatment adherence 4
By following these safety considerations, healthcare providers can minimize infection transmission risks while optimizing the delivery of inhaled medications in patients requiring IVAPS ventilatory support.