title: Use of a Shared Canister Protocol for the Delivery of Metered-Dose Inhalers in Mechanically Ventilated Subjects.
abstract: BACKGROUND
  Mechanically ventilated patients often need bronchodilators administered via a metered-dose inhaler (MDI). Unfortunately, there are no data examining the impact of shared canister delivery of MDI therapy in mechanically ventilated patients.
  
  
  METHODS
  A prospective trial was conducted with subjects assigned to shared canister MDI therapy or single-patient canister MDI therapy. Outcomes assessed were occurrence of ventilator-associated pneumonia (VAP), hospital mortality, length of stay, ventilator-associated events, and MDI costs.
  
  
  RESULTS
  Among 486 screened patients, 353 were included for analysis of which 201 (56.9%) received shared canister MDI therapy and 152 (43.1%) received single-patient canister therapy. VAP (7.0% vs 4.6%, P = .35), hospital mortality (21.9% vs 20.4%, P = .73), and ventilator days (median [interquartile range] 3.1 [0.9-7.5] d vs 2.7 [1.2-7.1] d, P = .62) were similar between the shared canister and single-patient canister groups. We did not observe clinically important differences for ventilator-associated events between study groups in our logistic regression analysis (P = .07). There was a savings of $217/subject in the shared canister group due to the use of 299 fewer MDIs.
  
  
  CONCLUSIONS
  Our study found that shared canister MDI therapy compared with single-patient MDI use was associated with a significant cost savings and similar rates of VAP, hospital mortality, and length of stay but a greater prevalence of ventilator-associated events. This finding suggests that shared canister delivery of MDIs may be a cost-effective practice in mechanically ventilated patients. Based on our findings, further studies examining the overall safety of shared canister use in mechanically ventilated patients seem warranted before recommending their routine use. (ClinicalTrials.gov registration NCT01935388.).
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Mollie
authors.initials: M
authors.lastname: Gowan
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bushwitz
authors.affiliation: Department of Respiratory Care Services, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Peggy
authors.initials: P
authors.lastname: Watts
authors.affiliation: Department of Respiratory Care Services, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Patty C
authors.initials: PC
authors.lastname: Silver
authors.affiliation: Department of Respiratory Care Services, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Mark
authors.initials: M
authors.lastname: Jackson
authors.affiliation: Center for Clinical Excellence, BJC HealthCare, St. Louis, Missouri.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hampton
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, Missouri. mkollef@dom.wustl.edu.
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000280:Administration, Inhalation; D000420:Albuterol / Q000008:administration & dosage; D001993:Bronchodilator Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D017052:Hospital Mortality; D009241:Ipratropium / Q000008:administration & dosage; D007902:Length of Stay; D016015:Logistic Models; D036501:Metered Dose Inhalers / Q000009:adverse effects / Q000191:economics; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D055397:Ventilator-Induced Lung Injury / Q000453:epidemiology / Q000209:etiology; D012122:Ventilators, Mechanical / Q000009:adverse effects
chemical_list: D000420:Albuterol; D001993:Bronchodilator Agents; D009241:Ipratropium
keywords: common canister; mechanical ventilation; outcome