title: Bronchodilator delivered by metered dose inhaler and spacer improves respiratory system compliance more than nebulizer-delivered bronchodilator in ventilated premature infants.
abstract: We compared the change in passive respiratory system compliance (Crs) and resistance (Rrs) after albuterol aerosol treatment administered by either low-flow nebulizer (NEB) or a metered dose inhaler (MDI) and spacer into a ventilator circuit. We hypothesized that albuterol delivered to ventilated infants older than 7 days of life by an MDI and a spacer would improve Crs more than albuterol delivered by a low-flow nebulizer. The treatments were administered 6 hr apart to premature infants with Crs < or = 0.8 mL/cm H2O per kg, requiring ventilation after 7 days of age. Patients served as their own controls and treatment order was randomized. Eighteen studies were performed in eight infants before and 1 and 3 hr after treatment. Differences between methods were compared by analyses of variance. Mean (range) birth weight and study age were 888 (619-1,283) g and 12 (7-29) days, respectively. Mean respiratory system compliance increased by 34% with MDI and by 11% with NEB at 1 hr after treatment (P < 0.02). By 3 hr after treatment, Crs returned to baseline with both methods of aerosol delivery. There was no significant difference in Rrs between the two methods at 1 and 3 hr after treatment. We conclude that albuterol delivered by MDI improves Crs more than low-flow NEB in ventilated premature infants.
authors.affiliation: Department of Pediatrics, California Pacific Medical Center, San Francisco 94118, USA.
authors.forename: D
authors.initials: D
authors.lastname: Sivakumar
authors.forename: E
authors.initials: E
authors.lastname: Bosque
authors.forename: S L
authors.initials: SL
authors.lastname: Goldman
mesh_terms: D000280:Administration, Inhalation; D000420:Albuterol / Q000008:administration & dosage*; D000704:Analysis of Variance; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000188:drug therapy* / Q000209:etiology; D008170:Lung Compliance / Q000187:drug effects; D008297:Male; D009330:Nebulizers and Vaporizers; D011446:Prospective Studies; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy* / Q000209:etiology; D015656:Respiratory Mechanics / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D000420:Albuterol