Comparison of one versus two bronchodilators in ventilated COPD patients.
OBJECTIVE
To compare the bronchodilating effect of a single drug, ipratropium bromide (IBr), with that of its combination with fenoterol (IBr+F).


METHODS
The study was triple blind and randomized.


METHODS
Medical-surgical intensive care unit.


METHODS
12 patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation for severe respiratory failure.


METHODS
Before administering each drug, peak airway pressure (Ppeak), end inspiratory pressure (Pei), resistive pressure (Pres), and auto positive--end expiratory pressure (auto-PEEP) were measured. Inspiratory system resistance (Rins) and dynamic respiratory system compliance (C) were calculated. Arterial pH and blood gas determinations were made. These measurements were repeated 60 min after administration of each therapeutic regimen. For ipratropium bromide alone the dose was 0.04 mg. When the combination of drugs was used, the doses were 0.04 mg for ipratropium bromide and 0.1 mg for fenoterol.


RESULTS
With the combination of both drugs, all the pressures in the airway, as well as the auto-PEEP and the Rins were significantly reduced (p < 0.05) with respect to baseline values. With ipratropium bromide alone, no significant changes were observed either in the pressures or in the inspiratory resistance. No significant changes were observed either in the pH or blood gases with any of the treatments. The combination of both drugs produced significantly reduction in Pei and auto-PEEP when compared with ipratropium bromide alone.


CONCLUSIONS
The combination of both drugs is more effective than ipratropium bromide alone at the doses used in this study.
Servicio de Cuidados Intensivos, Hospital Universitario de Getafe, Madrid, Spain.
A
A
Fernandez
J
J
Muñoz
B
B
de la Calle
I
I
Alia
A
A
Ezpeleta
M A
MA
de la Cal
A
A
Reyes
D000208:Acute Disease; D000368:Aged; D000403:Airway Resistance; D001784:Blood Gas Analysis; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D005260:Female; D005280:Fenoterol / Q000627:therapeutic use*; D005541:Forced Expiratory Volume; D006801:Humans; D007362:Intensive Care Units; D009241:Ipratropium / Q000627:therapeutic use*; D008170:Lung Compliance; D008173:Lung Diseases, Obstructive / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D014797:Vital Capacity
D005280:Fenoterol; D009241:Ipratropium