RT Journal Article
SR Electronic
T1 Utilization of Bronchodilators in Ventilated Patients Without Obstructive Airways Disease
JF Respiratory Care
FD American Association for Respiratory Care
SP 154
OP 158
VO 52
IS 2
A1 Lydia H Chang
A1 Shyoko Honiden
A1 John A Haithcock
A1 Aneesa M Das
A1 Kathy A Short
A1 David M Nierman
A1 Shannon S Carson
YR 2007
UL http://rc.rcjournal.com/content/52/2/154.abstract
AB 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 ≥ 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 PaO2/FIO2 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 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.