We routinely use a 22-mm male/ 22-mm female connector with a metered-dose inhaler insert (Intersur-gical Ltd, Wokingham, Berkshire, UK) on our intensive care unit to administer aerosolised metered-dose inhaler drugs in preference to nebulised formulations (Fig. 4). This mode of delivery is effective provided that a proper technique is employed. The device is inexpensive, intuitive to use and allows reliable drug dosing. The device is located in line with the ventilator circuit as close to the patient as possible, and the metered-dose inhaler aerosol delivered in synchrony with inspiration.
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