title: Metered dose inhalers for bronchodilator delivery in intubated, mechanically ventilated patients.
abstract: We determined the relative efficacy of two bronchodilator aerosol delivery methods in 18 intubated mechanically ventilated patients with airways obstruction. Two treatment arms, consisting of albuterol 270 micrograms (three puffs) from a metered dose inhaler and albuterol 2.5 mg from a saline solution nebulized with an updraft inhaler, were compared in a single blind, randomized crossover design. Pulmonary function was evaluated using an interrupter technique. Changes in passive expiratory flow at respiratory system recoil pressures between 6 and 10 cm H2O provided the therapeutic endpoints. Paired measurements were made before and 30 minutes after drug delivery. The MDI and NEB resulted in similar improvements in iso-recoil flow (mean increase for both groups = 0.1 L/s). Treatment sequence, severity of obstruction, and bronchodilator responsiveness had no effect on relative efficacy. Albuterol caused a small but significant increase in heart rate that was similar following both delivery methods. We conclude that bronchodilator aerosol delivery with metered dose inhalers provides a viable alternative to nebulizer therapy in intubated mechanically ventilated patients and may result in a cost savings to hospitals and patients.
authors.affiliation: Department of Internal Medicine and Thoracic Diseases, Mayo Graduate School of Medicine, Rochester, MN 55905.
authors.forename: P C
authors.initials: PC
authors.lastname: Gay
authors.forename: H G
authors.initials: HG
authors.lastname: Patel
authors.forename: S B
authors.initials: SB
authors.lastname: Nelson
authors.forename: B
authors.initials: B
authors.lastname: Gilles
authors.forename: R D
authors.initials: RD
authors.lastname: Hubmayr
mesh_terms: D000336:Aerosols; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage* / Q000627:therapeutic use; D001249:Asthma / Q000628:therapy; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008173:Lung Diseases, Obstructive / Q000628:therapy; D008297:Male; D009330:Nebulizers and Vaporizers; D012121:Respiration, Artificial; D016037:Single-Blind Method
chemical_list: D000336:Aerosols; D000420:Albuterol