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Aerosolized medications are commonly used in mechanically ventilated patients. A number of potential factors influence the deposition of aerosolized drugs in the ventilated patient. In this article the mechanisms of aerosol production and delivery techniques to patients requiring mechanical ventilation are reviewed. Factors that can affect aerosol deposition in these patients are also examined. This review also analyzes the available data for clinical efficacy of bronchodilators in the mechanically ventilated patient population. Lastly, the authors review potential complications of bronchodilator therapy and provide recommendations for the administration of bronchodilators to patients requiring mechanical ventilation. Although the principles of aerosol delivery are similar for adult and pediatric patients, this article will focus on studies performed on adult patients or with adult models of mechanical ventilation.