title: A comparison of metered-dose inhaled albuterol versus endotracheal liquid bolus albuterol for the treatment of bronchoconstriction.
abstract: BACKGROUND
  Aerosolized albuterol delivery is a mainstay treatment for bronchoconstriction; however, almost no data exist that evaluate the clinical outcome of instillation of an endotracheal liquid bolus (ELB) of a bronchodilator directly into the airway.
  
  
  METHODS
  This randomized trial sought to evaluate the efficacy of albuterol lavage via artificial airway with accompanied patient positioning. Subjects receiving mechanical ventilation for acute respiratory failure with clinical manifestations of bronchoconstriction were assigned to initially receive either traditional albuterol via metered-dose inhaler (MDI) or albuterol via ELB lavage with follow-up administration of the other therapy after a 4-h washout period. Clinical data were collected at baseline and at 5 and 30 min post-treatment.
  
  
  RESULTS
  Fourteen subjects (5 males, 9 females; mean age of 57.5 y) were included in this study. In the group receiving initial ELB, peak airway pressure decreased significantly (P = .02), and a significant decrease in airway resistance mean scores was seen from baseline to 30 min post-treatment (P < .001) and from 5 to 30 min post-treatment (P = .003), with no significant effects seen with follow-up MDI. In the initial MDI treatment group, no significant effect on peak airway pressure or airway resistance was noted. S(pO2) increased at 5 min post-treatment with ELB. In contrast, S(pO2) decreased 30 min post-treatment with MDI. Mean arterial pressure decreased post-treatment with ELB. The pattern in heart rate change post-treatment with ELB was similar to that post-treatment with MDI, with a significant increase at the 5-min interval from baseline (P < .01), followed by a significant decrease at the 30-min interval (P < .001). There were no differences in dynamic compliance at each time interval following administration of both the MDI (P = .92) and ELB conditions (P = .18).
  
  
  CONCLUSIONS
  ELB albuterol lavage may be a viable option to reverse bronchoconstriction in intubated patients with limited response to traditional aerosolized albuterol via MDI.
authors.affiliation: Louisiana State University Health Sciences Center, Shreveport, Louisiana, at the time of this study but is currently affiliated with University Health Shreveport, Shreveport, Louisiana. DonaldAJohnston@gmail.com.
authors.forename: Donald A
authors.initials: DA
authors.lastname: Johnston
authors.affiliation: Louisiana State University Health Sciences Center, Shreveport, Louisiana.
authors.forename: Tim W
authors.initials: TW
authors.lastname: Gilmore
authors.affiliation: Texas A&M Health Science Center, Bryan, Texas.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Gosselin
mesh_terms: D000403:Airway Resistance; D000420:Albuterol / Q000008:administration & dosage*; D018893:Bronchoalveolar Lavage / Q000379:methods*; D016084:Bronchoconstriction / Q000187:drug effects*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D036501:Metered Dose Inhalers; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D000420:Albuterol
keywords: albuterol lavage; albuterol liquid bolus; novel use albuterol