title: Inhaled β2-Agonist Therapy Increases Functional Residual Capacity in Mechanically Ventilated Children With Respiratory Failure.
abstract: OBJECTIVE
  To test the hypothesis that in mechanically ventilated children with respiratory failure, aerosolized albuterol modifies functional residual capacity, lung mechanics, oxygen consumption, and hemodynamics.
  
  
  METHODS
  Prospective, self-control clinical trial.
  
  
  METHODS
  A 24-bed PICU in a quaternary care, academic children's hospital.
  
  
  METHODS
  25 children (age range, 1-18 yr) undergoing mechanical ventilation to treat respiratory failure. Entry criteria included previously prescribed inhaled β2 agonists. Physiologic measurements were performed prior to and 20 minutes after administration of aerosolized albuterol solution. Functional residual capacity was determined via nitrogen washout.
  
  
  METHODS
  Functional residual capacity, oxygen consumption, respiratory mechanics, and vital signs were measured were measured prior to and 20 minutes after administration of aerosolized albuterol solution. Functional residual capacity was determined via nitrogen washout.
  
  
  RESULTS
  At baseline, functional residual capacity is only 53% of predicted. After aerosolized albuterol, functional residual capacity increased by 18.3% (p = 0.008). Overall, aerosolized albuterol had no effect on airway resistance. However, in patients with an endotracheal tube size of more than or equal to 4.0 mm, resistance decreased from 33 ± 3 to 25 ± 3 (p < 0.02). Inhaled albuterol administration had no effect on oxygen consumption despite an increase in heart rate from 116 ± 2 to 128 ± 2 beats/min (p < 0.0001).
  
  
  CONCLUSIONS
  In pediatric patients with respiratory failure, aerosolized albuterol increases functional residual capacity without a decrease in resistance. In infants and children, aerosolized albuterol might favorably enhance pulmonary mechanics and thereby represent a novel strategy for lung recruitment in children with respiratory failure.
authors.affiliation: 1Division of Pediatric Critical Care Medicine, Sheikh Khalifa Medical City (SKMC) in affiliation with Cleveland Clinic, Abu Dhabi, United Arab Emirates. 2Respiratory Therapy Department, Lucile Packard Children's Hospital at Stanford University, Palo Alto, CA. 3Division of Pulmonary Medicine, Center for Excellence in Pulmonary Biology, Stanford University School of Medicine, Stanford, CA. 4Department of Pediatrics, Center for Excellence in Pulmonary Biology, Stanford University School of Medicine, Stanford, CA.
authors.forename: Musaab A
authors.initials: MA
authors.lastname: Ramsi
authors.forename: Michael
authors.initials: M
authors.lastname: Henry
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Milla
authors.forename: David N
authors.initials: DN
authors.lastname: Cornfield
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage*; D000420:Albuterol / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D005652:Functional Residual Capacity / Q000187:drug effects; D006801:Humans; D007223:Infant; D008168:Lung / Q000503:physiopathology*; D008297:Male; D010101:Oxygen Consumption / Q000502:physiology; D011446:Prospective Studies; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000503:physiopathology*
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D000420:Albuterol