Accumulated airway secretions in the endotracheal tube increase work of breathing and may favor airway colonization eventually leading to pneumonia. The aim of this preplanned substudy of the ‘Preventive Nebulization of Mucolytic Agents and Bronchodilating Drugs in Intubated and Ventilated Intensive Care Unit Patients trial’ (NEBULAE) was to compare the effect of routine vs on-demand nebulization of acetylcysteine with salbutamol on accumulation of secretions in endotracheal tubes in critically ill patients. In this single-center substudy of a national multicenter trial, patients were randomized to a strategy of routine nebulizations of acetylcysteine with salbutamol every 6 h until end of invasive ventilation, or to a strategy with on-demand nebulizations of acetylcysteine or salbutamol applied on strict clinical indications only. The primary endpoint, the maximum reduction in cross-sectional area (CSA) of the endotracheal tube was assessed with high-resolution computed tomography. Endotracheal tubes were collected from 72 patients, 36 from patients randomized to the routine nebulization strategy and 36 of patients randomized to the on-demand nebulization strategy. The maximum cross-sectional area (CSA) of the endotracheal tube was median 12 [6 to 15]% in tubes obtained from patients in the routine nebulization group, not different from median 9 [6 to 14]% in tubes obtained from patients in the on-demand nebulization group (P = 0.33). In adult critically ill patients under invasive ventilation, routine nebulization of mucolytics and bronchodilators did not affect accumulation of airway secretions in the endotracheal tube. Trial registration Clinicaltrials.gov Identifier: NCT02159196

中文翻译：

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乙酰半胱氨酸与沙丁胺醇的常规与按需雾化对气管导管中气道分泌物积聚的影响：随机临床试验的子研究

气管内导管中积聚的气道分泌物会增加呼吸功，并可能有利于气道定植，最终导致肺炎。“插管和通气重症监护病房患者试验中粘液溶解剂和支气管扩张药物的预防性雾化”(NEBULAE) 的这项预先计划的子研究的目的是比较常规与按需雾化乙酰半胱氨酸和沙丁胺醇对分泌物积累的影响在危重病人的气管插管中。在这项国家多中心试验的单中心子研究中，患者被随机分配到每 6 小时常规雾化乙酰半胱氨酸和沙丁胺醇直至有创通气结束的策略，或按需雾化乙酰半胱氨酸或沙丁胺醇的策略。仅临床适应症。主要终点，气管插管横截面积（CSA）的最大减少是通过高分辨率计算机断层扫描评估的。从 72 名患者中收集了气管插管，其中 36 名来自随机分配到常规雾化策略的患者和 36 名随机分配到按需雾化策略的患者。从常规雾化组患者获得的气管插管的最大横截面积 (CSA) 的中位数为 12 [6 至 15]%，与从患者获得的管中的中位数 9 [6 至 14]% 没有区别。按需雾化组 (P = 0.33)。在有创通气下的成年危重患者中，粘液溶解剂和支气管扩张剂的常规雾化不影响气管内导管中气道分泌物的积聚。试验注册 Clinicaltrials.gov 标识符：