Antibiotic aerosolisation in patients with ventilator-associated pneumonia (VAP) has renewed potential with the recent development of a new generation of nebuliser, which uses a vibrating mesh. However, data in humans are limited, and with the exception of one randomised study, most of the reported incidents are of case reports, descriptive studies or literature reviews. The unique randomised study, so far only published as an abstract, showed that amikacin aerosolised with a vibrating-mesh nebuliser, a new generation device, was well distributed in the lung parenchyma and might lead to reduced intravenous antibiotics use. Recent pharmacokinetics studies on amikacin nebulisation with vibrating-mesh nebulisers showed promising results. Prospective cohort or retrospective studies showed that colistin nebulisation could be of interest in patients with VAP due to multiresistant strains.
Despite recent promising findings, the widespread use of aerosolised antibiotics to treat VAP cannot be recommended. It should be restricted to the treatment of multidrug-resistant Gram-negative VAP. In these cases, using a vibrating-mesh nebuliser seems to be more efficient.