Treatment of bronchospasm by metered-dose inhaler albuterol in mechanically ventilated patients.
beta 2-agonist bronchodilators delivered by metered-dose inhalers (MDI) are commonly used in the treatment of bronchospasm in both intubated and nonintubated patients. Substantial data support the effectiveness of MDI delivery systems in nonintubated patients. However, few studies have examined the effectiveness of MDIs in intubated, mechanically ventilated patients. MDIs are often used in conjunction with a spacing device that may enhance delivery of drug to the airways, but few in vivo data have demonstrated efficacy of this delivery method in ventilated patients. We studied ten critically ill patients who had a peak (Ppeak) to pause (Ppause) gradient of more than 15 cm H2O during sedated, quiet breathing on assist control ventilation. We administered 5, 10, and 15 puffs (90 micrograms per puff) of MDI albuterol through a specific spacer (Aerovent) at 30-min intervals, while measuring resistive pressure (defined as Ppeak-Ppause) before and after treatments. Resistive airway pressure after 5 puffs decreased in nine of ten patients, from 25.1 +/- 7.2 to 20.8 +/- 5.6 cm H2O (p < 0.12). The addition of 10 more puffs further reduced resistive pressure in nine of nine patients from 20.8 +/- 5.6 to 19.0 +/- 4.4 (p < 0.01). Fifteen more puffs (30 cumulative puffs) did not result in further improvement (p > 0.5). A toxic reaction occurred in one patient (systolic blood pressure decreased 20 mm Hg) after 5 puffs of albuterol. We conclude that MDI administered through this specific spacer is effective in mechanically ventilated patients in doses up to 15 puffs, and that therapy should be titrated to effectiveness and toxicity.
Manthous
C A
CA
Department of Internal Medicine, Bridgeport Hospital, New Haven, Conn 06610.
Chatila
W
W
Schmidt
G A
GA
Hall
J B
JB
D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000403:Airway Resistance / Q000187:drug effects; D000420:Albuterol / Q000008:administration & dosage* / Q000009:adverse effects; D001986:Bronchial Spasm / Q000188:drug therapy* / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D012121:Respiration, Artificial
D000420:Albuterol