Practice pattern of aerosol drug therapy in acute respiratory distress syndrome patients: An aero-in-ICU study

A new review led by Associate Professor Sanjay Singhal from Dr. Ram Manohar Lohia Institute of Medical Sciences sheds light on the prevalence and practice patterns of ADT in patients with ARDS. The study was made available online on 05 July 2025 and was published in the  Journal of Intensive Medicine.

Aerosol therapy is frequently used in critically ill patients admitted to intensive care units (ICUs) worldwide. Previously published studies have shown that most of these patients do not have chronic respiratory disease, and aerosol drug therapy (ADT) is still used. In general, the use of bronchodilators in critically ill patients, other than those with obstructive airway disease, does not routinely impact outcomes.

However, various preclinical and clinical studies on acute respiratory distress syndrome (ARDS) have suggested a possible role for aerosol therapy in accelerating the resolution of pulmonary edema by enhancing fluid and mucociliary clearance, as well as controlling inflammation.  Despite a strong physiological and scientific rationale, randomized controlled clinical trials failed to demonstrate the benefits of aerosol therapy in patients with established ARDS. Despite the scarcity of sound scientific evidence and various consensus recommendations by societies, ADT is still used to manage patients with ARDS.

“This multicentric, prospective observational cohort study (Aero-in-ICU) showed that ADT is frequently used in ARDS, with Bronchodilators being the most commonly prescribed drugs through a jet nebulizer, with half of the aerosol sessions at the optimum position (without the use of any expiratory filter,” says Dr. Singhal, the corresponding author.

This study emphasizes the need for standardized protocols and further research to align clinical practice with evidence-based recommendations.

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Reference
DOI: 10.1016/j.jointm.2025.05.003

About Associate Professor Sanjay Singhal
Dr. Sanjay Singhal is an Associate Professor of Pulmonary Medicine at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India. After completing his MD in Pulmonary Medicine from King George’s Medical University, his research has centered on critical care, aerosol drug therapy, and respiratory disorders. He has authored more than 100 publications and leads notable studies such as the Aero-in-ICU project. Recognized for his expertise in pulmonary and critical care medicine, he continues to contribute as both a researcher and educator, advancing respiratory health.