INTRODUCTION:Aerosolized albuterol delivery is a mainstay treatment for bronchoconstriction; however, almost no data exist that evaluate the clinical outcome of instillation of an endotracheal liquid bolus (ELB) of a bronchodilator directly into the airway. METHODS: This randomized trial sought to evaluate the efficacy of albuterol lavage via artificial airway with accompanied patient positioning. Subjects receiving mechanical ventilation for acute respiratory failure with clinical manifestations of bronchoconstriction were assigned to initially receive either traditional albuterol via metered-dose inhaler (MDI) or albuterol via ELB lavage with follow-up administration of the other therapy after a 4-h washout period. Clinical data were collected at baseline and at 5 and 30 min post-treatment. RESULTS: Fourteen subjects (5 males, 9 females; mean age of 57.5 y) were included in this study. In the group receiving initial ELB, peak airway pressure decreased significantly (P ؍ .02), and a significant decrease in airway resistance mean scores was seen from baseline to 30 min post-treatment (P < .001) and from 5 to 30 min post-treatment (P ؍ .003), with no significant effects seen with follow-up MDI. In the initial MDI treatment group, no significant effect on peak airway pressure or airway resistance was noted. S pO 2 increased at 5 min post-treatment with ELB. In contrast, S pO 2 decreased 30 min post-treatment with MDI. Mean arterial pressure decreased post-treatment with ELB. The pattern in heart rate change post-treatment with ELB was similar to that post-treatment with MDI, with a significant increase at the 5-min interval from baseline (P < .01), followed by a significant decrease at the 30-min interval (P < .001). There were no differences in dynamic compliance at each time interval following administration of both the MDI (P ؍ .92) and ELB conditions (P ؍ .18). CONCLUSIONS: ELB albuterol lavage may be a viable option to reverse bronchoconstriction in intubated patients with limited response to traditional aerosolized albuterol via MDI. Key words: albuterol liquid bolus; albuterol lavage; novel use albuterol. [Respir Care 2015;60(5):627-635.
Introduction: Acute Respiratory Distress Syndrome (ARDS) is a common fi nding among pediatric and adult patient populations [1]. ARDS-related mortality remains high and is associated with prolonged hospital Length of Stay (LOS) and multiple ventilator days. Studies have sought to predict whether certain risk factors can be associated with ARDS development and mortality. It remains to be established whether a strong association exists between ARDS patient demographic characteristics, hospital LOS and overall ARDS-related mortality [4]. Methods: A retrospective analysis of Electronic Health Record (EHR) data identifi ed 595 adult subjects that received an ARDS diagnosis: ICD-9: 518.82, ICD-10: J96.00 or J80 annotation. The analysis spanned a 30-month period, evaluating subjects by age, gender, race, BMI, LOS, and mortality. Results: The majority of subjects were admitted through the Emergency Department (408: 68.6%) and were followed by Internal Medicine (137: 23%) or Trauma service (117: 19.7%). A signifi cant portion of subjects expired (130: 21.8%), but a majority were discharged to home care (212: 35.6%). A binomial logistic regression was performed to identify whether a prevalence or risk ratio could be identifi ed between subject demographics and either LOS or mortality. LOS in days was associated with an increased likelihood of mortality (1.055), and age at admission was associated with a reduction in the likelihood of mortality (0.986). Conclusions: No statistically signifi cant predictor of mortality was identifi ed among subject demographic variables. The fi ndings did suggest that mortality in subjects was higher with longer hospital LOS, lower overall in younger subjects, and inversely related to BMI.
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