Salbutamol delivery during non-invasive mechanical ventilation in patients with chronic obstructive pulmonary disease: a randomized, controlled study.
OBJECTIVE
We investigated the clinical response to equivalent doses of salbutamol delivered, via metered dose inhaler (MDI) during non-invasive mechanical ventilation (NIMV-MDI), during spontaneous breathing using a spacer (MDI-Spacer), and also during intermittent positive pressure breathing (IPPB).


METHODS
A respiratory intensive care unit.


METHODS
Prospective, randomized, and placebo-controlled study.


METHODS
Eighteen stable patients with chronic obstructive pulmonary disease (mean FEV1=38.5+/-8.8% predicted).


RESULTS
Overall salbutamol administration induced, compared to placebo, a significant improvement in FEV1, irrespective of the mode of administration (+7.9+/-7.1% or +108+/-91 ml for IPPB, +9.6+/-8.8% or 112+/-67 ml for MDI-NIMV (inspiratory pressure=14.3+/-1.8 cmH2O; expiratory pressure=none), and +10.8+/-11.4% or 119+/-114 ml for MDI-Spacer, respectively). DeltaFVC significantly increased from placebo only in MDI-NIMV (+214+/-182 ml P=0.02). A second set of experiments performed in eight patients to ascertain the possible effect of NIMV on pulmonary function tests, showed a significant improvement from baseline values in FVC both after the delivering of placebo or salbutamol via NIMV-MDI (+206+/-147 ml and 208+/-145, respectively). FEV1 significantly increased only after salbutamol. No changes in gas exchange were observed after bronchodilator delivery.


CONCLUSIONS
We show that delivery of bronchodilators via MDI with a spacer chamber during NIMV is feasible and induces a significant bronchodilator effect compared to placebo, even though it may be slightly less effective than the classical delivery system (MDI-Spacer).
Nava
S
S
Respiratory Intensive Care Unit, Istituto Scientifico di Pavia, Fondazione S.Maugeri, IRCCS, via Ferrata 8, 27100 Pavia, Italy. snava@fsm.it
Karakurt
S
S
Rampulla
C
C
Braschi
A
A
Fanfulla
F
F
D000280:Administration, Inhalation; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage* / Q000494:pharmacology; D001784:Blood Gas Analysis; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000494:pharmacology; D003422:Critical Care / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007384:Intermittent Positive-Pressure Breathing / Q000295:instrumentation / Q000379:methods; D008297:Male; D008397:Masks; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D012121:Respiration, Artificial / Q000295:instrumentation* / Q000379:methods*; D013990:Tidal Volume; D016896:Treatment Outcome; D014797:Vital Capacity / Q000187:drug effects
D001993:Bronchodilator Agents; D000420:Albuterol