Journal article
Treatment of Bronchospasm by Metered-Dose Inhaler Albuterol in Mechanically Ventilated Patients
Chest, Vol.107(1), pp.210-213
01/1995
DOI: 10.1378/chest.107.1.210
PMID: 7813280
Abstract
β -agonist bronchodilators delivered by metered-dose inhalers (MDI) are commonly used in the treatment of bronchospasm in both intubated and nonintubated patients. Substantial data support the effectiveness of MDI delivery systems in nonintubated patients. However, few studies have examined the effectiveness of MDIs in intubated, mechanically ventilated patients. MDIs are often used in conjunction with a spacing device that may enhance delivery of drug to the airways, but few in vivo data have demonstrated efficacy of this delivery method in ventilated patients. We studied ten critically ill patients who had a peak (Ppeak) to pause (Ppause) gradient of more than 15 cm H2O during sedated, quiet breathing on assist control ventilation. We administered 5, 10, and 15 puffs (90 µg per puff) of MDI albuterol through a specific spacer (Aerovent) at 30-min intervals, while measuring resistive pressure (defined as Ppeak−Ppause) before and after treatments. Resistive airway pressure after 5 puffs decreased in nine of ten patients, from 25.1±7.2 to 20.8±5.6 cm H2O (p<0.12). The addition of 10 more puffs further reduced resistive pressure in nine of nine patients from 20.8±5.6 to 19.0±4.4 (p<0.01). Fifteen more puffs (30 cumulative puffs) did not result in further improvement (p>0.5). A toxic reaction occurred in one patient (systolic blood pressure decreased 20 mm Hg) after 5 puffs of albuterol. We conclude that MDI administered through this specific spacer is effective in mechanically ventilated patients in doses up to 15 puffs, and that therapy should be titrated to effectiveness and toxicity.
Details
- Title: Subtitle
- Treatment of Bronchospasm by Metered-Dose Inhaler Albuterol in Mechanically Ventilated Patients
- Creators
- Constantine A Manthous - From the Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Bridgeport Hospital and Yale University School of Medicine, New Haven, ConnWissam Chatila - From the Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Bridgeport Hospital and Yale University School of Medicine, New Haven, ConnGregory A Schmidt - From the Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Bridgeport Hospital and Yale University School of Medicine, New Haven, ConnJesse B Hall - From the Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Bridgeport Hospital and Yale University School of Medicine, New Haven, Conn
- Resource Type
- Journal article
- Publication Details
- Chest, Vol.107(1), pp.210-213
- Publisher
- Elsevier Inc
- DOI
- 10.1378/chest.107.1.210
- PMID
- 7813280
- ISSN
- 0012-3692
- eISSN
- 1931-3543
- Language
- English
- Date published
- 01/1995
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9984094623102771
Metrics
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