Chest

Chest

Volume 99, Issue 1, January 1991, Pages 66-71
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Metered Dose Inhalers for Bronchodilator Delivery in Intubated, Mechanically Ventilated Patients

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We determined the relative efficacy of two bronchodilator aerosol delivery methods in 18 intubated mechanically ventilated patients with airways obstruction. Two treatment arms, consisting of albuterol 270 μg (three puffs) from a metered dose inhaler and albuterol 2.5 mg from a saline solution nebulized with an updraft inhaler, were compared in a single blind, randomized crossover design. Pulmonary function was evaluated using an interrupter technique. Changes in passive expiratory flow at respiratory system recoil pressures between 6 and 10 cm H2O provided the therapeutic endpoints. Paired measurements were made before and 30 minutes after drug delivery. The MDI and NEB resulted in similar improvements in iso-recoil flow (mean increase for both groups = 0.1 L/s). Treatment sequence, severity of obstruction, and bronchodilator responsiveness had no effect on relative efficacy. Albuterol caused a small but significant increase in heart rate that was similar following both delivery methods. We conclude that bronchodilator aerosol delivery with metered dose inhalers provides a viable alternative to nebulizer therapy in intubated mechanically ventilated patients and may result in a cost savings to hospitals and patients. (Chest 1991; 99:66–71)

Section snippets

Study Papulation

Twenty adult ventilator-dependent patients, in whom the physician in charge had ordered bronchodilator aerosols for suspected airways obstruction, consented to be studied. All patients were clinically stable, as indicated by the absence of hypotension, tachycardia, and/or cardiac arrhythmias. Two patients were excluded from this report, because our tests did not confirm a diagnosis of airways obstruction.

Measurement Techniques

Airway pressure (Pao) and flow ( V˙) were measured at the oral end of the

Battent Characteristics

Thirteen men and five women with a mean age of 69 years were studied. Fifteen patients had been smokers. Twelve required intubation and mechanical ventilation for acute respiratory failure caused by primary lung disease, while six had undergone a major surgical procedure and remained ventilator-dependent for some time thereafter. Eleven patients were thought to have asthma or COPD by the physician who took care of them prior to this hospitalization. Five of 18 had used bronchodilator aerosols

DISCUSSION

The demand for nebulizer compressor units for home and hospital use continues to increase despite the proven therapeutic efficacy of the cheaper metered-dose inhalers in both clinical settings.1, 2, 3, 4, 5, 6,12 In part, this trend is rooted in a physician bias that nebulizers achieve a higher drug deposition rate in the airways, particularly in elderly patients who have difficulties with a coordinated MDI actuation.13 Careful instruction and the incorporation of spacer devices has increased

ACKNOWLEDGMENTS

The authors would like to thank Mrs. Lori Oeltjenbruns for her assistance in preparing this manuscript.

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    • Cited by (0)

    This study was supported by grant HL 38107.

    Manuscript received March 26; revision accepted July 11.

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    Copyright © 1991 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.