Inhaled fenoterol-ipratropium bromide in mechanically ventilated patients with chronic obstructive pulmonary disease.
In 18 patients with chronic obstructive pulmonary disease intubated and mechanically ventilated, we prospectively randomized 200 micrograms fenoterol-80 micrograms ipratropium bromide (four puffs) from a metered-dose inhaler (MDI) versus 1.25 mg fenoterol-500 micrograms ipratropium bromide in 5 ml saline from a nebulizer (NEB). Respiratory mechanics were assessed before and 30 min after the end of each delivery by the rapid end-inspiratory airway occlusion technique. We did vary on single breaths the inflation flow (V) from 0.2 to 1.2 L. s-1, at constant inflation volume. The total respiratory resistance of the respiratory system (Rrs) was partitioned into airway (Rint,rs) and tissue (DeltaRrs) resistances. We found that Rrs was equivalently reduced, from 16.49 +/- 1.37 to 14.85 +/- 1.88 cm H2O. L-1. s with MDI (p < 0.05) and from 18.04 +/- 1.85 to 15.15 +/- 1.33 cm H2O. L-1. s with NEB (p < 0.01). Whereas the prevailing effect of MDI was to reduce Rint,rs, that of NEB was to decrease DeltaRrs. In addition, the V resistance of the respiratory system over the whole range of V was significantly affected by NEB but not by MDI.
Guerin
C
C
Service de Réanimation Médicale, Centre Hospitalier Lyon-Sud, Pierre-Bénite, Service Central d'Explorations Fonctionnelles Respiratiores, Groupe Hospitalier Pitié-Salpétriére, Paris, France.
Chevre
A
A
Dessirier
P
P
Poncet
T
T
Becquemin
M H
MH
Dequin
P F
PF
Le Guellec
C
C
Jacques
D
D
Fournier
G
G
D000280:Administration, Inhalation; D000336:Aerosols; D000368:Aged; D000403:Airway Resistance; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D018592:Cross-Over Studies; D004338:Drug Combinations; D005260:Female; D005280:Fenoterol / Q000008:administration & dosage*; D006801:Humans; D009241:Ipratropium / Q000008:administration & dosage*; D008173:Lung Diseases, Obstructive / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D009330:Nebulizers and Vaporizers; D011446:Prospective Studies; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D016037:Single-Blind Method
D000336:Aerosols; D001993:Bronchodilator Agents; D004338:Drug Combinations; C030809:fenoterol, ipratropium drug combination; D005280:Fenoterol; D009241:Ipratropium