Aerosol Delivery Techniques in Mechanical Ventilation

Aerosol delivery during mechanical ventilation is a critical component of respiratory care for intubated and critically ill patients, offering targeted drug administration to the lower airways while minimising systemic exposure. Successful therapy depends on the interplay of device type, patient-specific factors and ventilator settings, including humidification, inspiratory flow patterns and circuit configuration. Nebulisers—jet, ultrasonic and vibrating mesh—each generate aerosols with distinct particle size distributions that influence regional deposition. Optimising the position of the nebuliser within the ventilator circuit, controlling relative humidity and selecting appropriate ventilation modes can markedly enhance lung dose and peripheral penetration. Continued innovation in ex vivo and in vivo models has advanced understanding of dose delivery and regional distribution, guiding clinical practice toward reproducible, efficient and safe aerosol administration under invasive mechanical ventilation.

Research from Nature Portfolio

Recent preclinical work has demonstrated that humidification level and nebuliser placement profoundly affect both total lung dose and regional deposition. In controlled ex-vivo porcine models, vibration-mesh nebulisers positioned immediately upstream of the Y-piece under dry conditions achieved more than double the lung-deposited fraction compared with positions near the ventilator, while humidification altered aerosol trajectory toward peripheral airways. A complementary ex-vivo respiratory tract model validated that approximately 18% of the nominal dose reaches the lung, with homogeneous regional ventilation and dose distribution consistent with human imaging studies. These findings underscore the importance of circuit configuration and environmental control to maximise therapeutic efficacy during invasive ventilation.

Aerosol Delivery Techniques in Mechanical Ventilation publication trend

The graph below shows the total number of articles in aerosol delivery techniques in mechanical ventilation across all publications each year (not limited to Nature Index journals).

Technical terms

Mechanical ventilation: A life-support technique that uses a machine to assist or replace spontaneous breathing by delivering air or gas mixtures into the lungs under controlled pressure or volume settings.

Aerosol deposition: The process by which airborne particles settle onto airway surfaces, influenced by particle size, airflow dynamics and airway geometry.

Vibrating mesh nebuliser: An aerosol generator that pushes liquid through a fine mesh with ultrasonic vibrations to produce uniformly small droplets for inhalation therapy.

Y-piece adapter: A junction in the ventilator circuit that connects the inspiratory and expiratory limbs to the patient’s endotracheal tube, often used as a mounting point for nebulisers or sensors.

Humidification: The addition of moisture to ventilator gas to maintain airway mucosal integrity and influence droplet size and trajectory during aerosol delivery.

References

1. Aerosol therapy in adult critically ill patients: a consensus statement regarding aerosol administration strategies during various modes of respiratory support. Annals of Intensive Care (2023).
2. Impact of gas humidification and nebulizer position under invasive ventilation: preclinical comparative study of regional aerosol deposition. Scientific Reports (2023).
3. Aerosol delivery during invasive mechanical ventilation: development of a preclinical ex vivo respiratory model for aerosol regional deposition. Scientific Reports (2019).
4. Position of different nebulizer types for aerosol delivery in an adult model of mechanical ventilation. Frontiers in Medicine (2022).