Bronchodilator delivery with metered-dose inhalers in mechanically-ventilated patients

Dhand, Rajiv; Tobin, Martin J.

doi:10.1183/09031936.96.09030585

Cited by 86 publications

(113 citation statements)

References 59 publications

(104 reference statements)

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“…these recommendations are based mainly on aerosol delivery data [11,12], which may not reflect drug bronchodilator effect. Indeed, in recent studies, it was shown that neither application of a 5 s end-inspiratory pause nor increasing the VT, strategies which probably enhanced drug delivery [4,5,11,12], augmented the bronchodilator effect of six puffs salbutamol [13,14]. The current study demonstrated that, at constant VT and inspiratory time, changing the inspiratory flow/time profile did not have any effect on salbutamol-induced bronchodilation, given via MDI and spacer.…”

Section: Discussionmentioning

confidence: 38%

“…The use of low inspiratory flow, high VT (> 500 mL), high duty cycle, decelerating rather than square-wave inspiratory/time profile and 3±5 s end-inspiratory pause has been suggested to increase the effectiveness of MDI therapy [4,5,11,12]. However.…”

Section: Discussionmentioning

confidence: 99%

“…The timing of drug delivery and ventilator parameters during the administration of bronchodilators, such as the tidal volume (VT), inspiratory flow/time profile and end-inspiratory pause (breath-hold), have been suggested to influence drug delivery to target sites and, thus, bronchodilation [4,5,11,12]. These suggestions, however, are based on in vitro studies using models of mechanical ventilation.…”

mentioning

confidence: 99%

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Bronchodilator delivery by metered-dose inhaler in mechanically ventilated COPD patients: influence of flow pattern

Mouloudi¹,

Prinianakis²,

Kondili³

et al. 2000

Eur Respir J

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In mechanically ventilated patients the flow pattern during bronchodilator delivery by metered-dose inhaler (MDI) could be a factor that might influence the effectiveness of this therapy. In order to test this the effect of two different inspiratory flow patterns on the bronchodilation induced by b 2 -agonists administered via MDI and spacer in a group of mechanically ventilated patients with chronic obstructive pulmonary disease (COPD) was examined.Eighteen mechanically ventilated patients with COPD, were prospectively randomized to receive two (n=8, protocol A) or six (n=10 protocol B) puffs salbutamol (100 mg . puff -1 ) either under pressure control (decelerating flow pattern) or under volume control (square wave flow pattern). With both modes, tidal volume and inspiratory time were identical. Salbutamol was administered via an MDI adapted to the inspiratory limb of the ventilator circuit using an aerosol cloud-enhancer spacer. After a 6-h washout, patients were crossed over to receive the same dose of salbutamol (200 or 600 mg, respectively in protocols A and B) by the alternative mode of administration. Static and dynamic airway pressures, minimum (Rint) and maximum (Rrs) inspiratory resistance and the difference between Rrs and Rint (DR) were measured before and at 15, 30 and 60 min after salbutamol.Independent of the dose, salbutamol caused a significant decrease in dynamic and static airway pressures, Rint and Rrs. These changes were not influenced by the inspiratory flow pattern and were evident at 15, 30 and 60 min after salbutamol.It is concluded that salbutamol delivered via metered dose inhaler and spacer device, induces significant bronchodilation in mechanically ventilated patients with chronic obstructive pulmonary disease, the magnitude of which is not affected by the inspiratory flow/time profile. Eur Respir J 2000; 16: 263±268. The delivery of bronchodilators via metered-dose inhalers (MDIs) in mechanically ventilated patients has received considerable interest in recent years [1±5]. It has been shown that MDIs adapted to the inspiratory line of the ventilator using a spacer device are as effective as nebulizers, despite the significantly lower dose of bronchodilator given by MDI [1±5]. A spacer device is thought to be fundamental to demonstrating the efficacy of the bronchodilatory therapy given by MDI [1±5]. Studies that delivered bronchodilators via MDI directly to the endotracheal tube failed to demonstrate any beneficial effect even after administration of high doses of bronchodilators [6]. The use of MDIs has several advantages over use of nebulizers, such as reduced cost, ease of administration, less personnel time, reliability of dosing and lower risk of contamination [7±10].The technique of administration of bronchodilators in mechanically ventilated patients using an MDI and a spacer is an important factor determining the efficacy of this therapy. The timing of drug delivery and ventilator parameters during the administration of bronchodilators, such as the tidal volume (V...

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Section: Discussionmentioning

confidence: 38%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Bronchodilator delivery by metered-dose inhaler in mechanically ventilated COPD patients: influence of flow pattern

Mouloudi¹,

Prinianakis²,

Kondili³

et al. 2000

Eur Respir J

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“…The efficiency of drug delivery through mechanical ventilation in adults is enhanced by many factors, including CPAP, mode (spontaneous breathing), 1 longer duty cycle and inspiratory time, 2 lower inspiratory flow, 3 and lower bias flow. 1,2,[4][5][6] Aerosol delivery varies with different types of aerosol generators, brands of nebulizer used, and their position in the ventilator circuit.…”

Section: Introductionmentioning

confidence: 99%

“…1,2,[4][5][6] Aerosol delivery varies with different types of aerosol generators, brands of nebulizer used, and their position in the ventilator circuit. [6][7][8] Other authors reported that the higher the peak inspiratory flow, the greater the impact of inspiratory waveform on aerosol delivery.…”

Section: Introductionmentioning

confidence: 99%

In Vitro Evaluation of Aerosol Delivery by Different Nebulization Modes in Pediatric and Adult Mechanical Ventilators

et al. 2014

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Albuterol samples collected in the inhalation filter, nebulizer, T-piece, and corrugated tubing were eluted with distilled water and analyzed with a spectrophotometer. RESULTS: The inhaled drug, as a percentage of total dose in both lung models, was 5.1-7.5%, without statistical significance among the 3 modes. Median nebulization times for IIM, CM, and EIM were 38.9, 14.3, and 17.7 min, respectively, and nebulization time for the 3 modes significantly differed (P < .001). The inhaled drug mass for the 3 modes with the adult lung model was similar to that with the pediatric lung model (7.39 ؎ 0.76 vs 6.27 ؎ 0.69%, P ‫؍‬ .77). CONCLUSIONS: Aerosol drug delivery with a jet nebulizer placed proximal to the ventilator was not dependent on nebulization mode during simulated pediatric and adult conventional mechanical ventilation. Use of expiratory intermittent mode and continuous nebulization should be considered to reduce treatment time.

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Metered dose inhalers versus nebulizers for aerosol bronchodilator delivery for adult patients receiving mechanical ventilation in critical care units

Holland

Smith

Veitch

et al. 2010

Cochrane Database of Systematic Reviews

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To compare nebulizers to MDIs for bronchodilator delivery for invasively ventilated critically ill adult patients in terms of physiological response and patient outcomes. Subgroup analyses are planned according to other ventilation and bronchodilation strategies, ventilator settings and administration variables.1 Metered dose inhalers versus nebulizers for aerosol bronchodilator delivery for adult patients receiving mechanical ventilation in critical care units (Protocol)

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Bronchodilator delivery with metered-dose inhalers in mechanically-ventilated patients

Cited by 86 publications

References 59 publications

Bronchodilator delivery by metered-dose inhaler in mechanically ventilated COPD patients: influence of flow pattern

Bronchodilator delivery by metered-dose inhaler in mechanically ventilated COPD patients: influence of flow pattern

In Vitro Evaluation of Aerosol Delivery by Different Nebulization Modes in Pediatric and Adult Mechanical Ventilators

Metered dose inhalers versus nebulizers for aerosol bronchodilator delivery for adult patients receiving mechanical ventilation in critical care units

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