Invasive mechanically assisted ventilation is a common treatment for intensive care unit (ICU) patients. Because of a variety of factors, including an aging population, the number of patients who receive mechanical ventilation is increasing. Each year, one-third of patients require mechanical ventilation (MV) for more than 48 h, and many patients require aerosol therapy during the MV. Aerosol therapy is a safe and convenient method of treatment and commonly used in patients with invasive MV in the ICU, especially for patients with asthma and chronic obstructive pulmonary disease. The three most commonly used aerosolizing drugs are bronchodilators, corticosteroids, and antibiotics. However, the effect of aerosolized inhalation is reduced due to the establishment of an artificial airway in a tracheal intubated patient. In patients with artificial airways, aerosol transmission was only one-sixth of what it was in patients without artificial airways. Over the past 25 years, with the development of aerosol equipment and operation technology, the aerosol delivery to invasive MV patients has almost been matched and even exceeded that reported in patients with nonartificial airways.

Intravenous milrinone, a phosphodiesterase inhibitor and inodilator, has long been used in cardiac surgery to manage pulmonary hypertension (PH), especially during challenging separations from cardiopulmonary bypass (CPB). A notable disadvantage of intravenous milrinone is its potential to cause systemic hypotension. To mitigate this risk, inhalation has been proposed as an alternative method of administration. Pulmonary drug delivery offers benefits such as rapid absorption, high bioavailability, and increased local concentrations. Over the past decade, it has been hypothesized that inhaling milrinone before CPB could protect against the worsening of PH in cardiac surgery patients by reducing CPB-induced inflammation, preventing pulmonary endothelial dysfunction, and easing CPB separation. A multicenter randomized controlled trial confirmed the clinical efficacy of inhaled milrinone in lowering PH levels, though it did not show a reduction in the difficulty of CPB separation. Several factors, including suboptimal drug delivery, may account for these findings.

Invasive mechanically assisted ventilation is a common treatment for intensive care unit (ICU) patients. Because of a variety of factors, including an aging population, the number of patients who receive mechanical ventilation is increasing. Each year, one-third of patients require mechanical ventilation (MV) for more than 48 h, and many patients require aerosol therapy during the MV. Aerosol therapy is a safe and convenient method of treatment and commonly used in patients with invasive MV in the ICU, especially for patients with asthma and chronic obstructive pulmonary disease. The three most commonly used aerosolizing drugs are bronchodilators, corticosteroids, and antibiotics. However, the effect of aerosolized inhalation is reduced due to the establishment of an artificial airway in a tracheal intubated patient. In patients with artificial airways, aerosol transmission was only one-sixth of what it was in patients without artificial airways. Over the past 25 years, with the development of aerosol equipment and operation technology, the aerosol delivery to invasive MV patients has almost been matched and even exceeded that reported in patients with nonartificial airways.

Intravenous milrinone, a phosphodiesterase inhibitor and inodilator, has long been used in cardiac surgery to manage pulmonary hypertension (PH), especially during challenging separations from cardiopulmonary bypass (CPB). A notable disadvantage of intravenous milrinone is its potential to cause systemic hypotension. To mitigate this risk, inhalation has been proposed as an alternative method of administration. Pulmonary drug delivery offers benefits such as rapid absorption, high bioavailability, and increased local concentrations. Over the past decade, it has been hypothesized that inhaling milrinone before CPB could protect against the worsening of PH in cardiac surgery patients by reducing CPB-induced inflammation, preventing pulmonary endothelial dysfunction, and easing CPB separation. A multicenter randomized controlled trial confirmed the clinical efficacy of inhaled milrinone in lowering PH levels, though it did not show a reduction in the difficulty of CPB separation. Several factors, including suboptimal drug delivery, may account for these findings.