Utilization of bronchodilators in ventilated patients without obstructive airways disease.
OBJECTIVE
To examine physician practice in, and the costs of, prescribing inhaled bronchodilators to mechanically ventilated patients who do not have obstructive lung disease.


METHODS
This was a prospective cohort study at 2 medical intensive care units at 2 tertiary-care academic medical centers, over a 6-month period. Included were the patients who required > or = 24 hours of mechanical ventilation but did not have obstructive lung disease. Excluded were patients who had obstructive lung disease and/or who had undergone > 24 hours of mechanical ventilation outside the study intensive care units.


RESULTS
Of the 206 patients included, 74 (36%) were prescribed inhaled bronchodilators without clear indication. Sixty-five of those 74 patients received both albuterol and ipratropium bromide, usually within the first 3 days of intubation (58 patients). Patients prescribed bronchodilators were more hypoxemic; their mean P(aO(2))/F(IO(2)) ratio was lower (188 mm Hg versus 238 mm Hg, p = 0.004), and they were more likely to have pneumonia (53% vs 33%, p = 0.007). The mean extra cost for bronchodilators was 449.35 dollars per patient. Between the group that did receive bronchodilators and the group that did not, there was no significant difference in the incidence of ventilator-associated pneumonia, tracheostomy, or mortality. The incidence of tachyarrhythmias was similar (15% vs 22%, p = 0.25).


CONCLUSIONS
A substantial proportion of mechanically ventilated patients without obstructive lung disease received inhaled bronchodilators.
Chang
Lydia H
LH
Division of Pulmonary and Critical Care Medicine, University of South Carolina, 8 Medical Park, Suite 410, Columbia SC 29203, USA. lchang@gw.mp.sc.edu
Honiden
Shyoko
S
Haithcock
John A
JA
Das
Aneesa M
AM
Short
Kathy A
KA
Nierman
David M
DM
Carson
Shannon S
SS
D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000420:Albuterol / Q000191:economics / Q000627:therapeutic use*; D001993:Bronchodilator Agents / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D009241:Ipratropium / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012121:Respiration, Artificial; D016896:Treatment Outcome; D019564:Unnecessary Procedures
D001993:Bronchodilator Agents; D009241:Ipratropium; D000420:Albuterol