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Clinical Investigations in Critical CareA Comparison of Bronchodilator Therapy Delivered by Nebulization and Metered-Dose Inhaler in Mechanically Ventilated Patients
Section snippets
Materials and Methods
This study was conducted in the Medical and Surgical ICUs at St. Vincent Hospital, a community teaching hospital in central Massachusetts. It was approved by the hospital's institutional review board. As all three delivery methods were concurrently being used in our ICUs, and they were dependent on the respiratory therapist's preferences, this protocol did not deviate from our standard of care, and the institutional review board therefore waived the need for informed consent. Mechanically
Results
Thirty patients were studied, with 10 randomized to each group. The patients’ clinical characteristics and ventilator settings are listed in Table 1. The amounts of albuterol recovered in the urine were 169 ± 129 μg (38%) using the MDI and spacer, 409 ± 515 μg (16%) using the nebulizer, and 41 ± 61 μg (9%) using the in-line MDI. The percentage of drug excreted differed significantly among all three groups (p = 0.02). The level of albuterol in the urine was below the level of detection in four
Discussion
In this study, we have confirmed that an MDI and spacer is an efficient method for delivering therapeutic aerosols in mechanically ventilated patients. Although the total dose of the drug delivered to the lung was greatest with the nebulizer, it was less efficient than the MDI and spacer. The MDI port on the right-angle adaptor resulted in significantly less delivery, with undetectable levels of the drug in a number of patients. Our study, therefore, emphasizes the improved delivery of aerosol
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Cited by (0)
The results of this study were presented in part at the 28th Educational and Scientific Symposium of the Society of Critical Care Medicine, San Francisco, CA, January 23 to 27, 1999.