Effect of ipratropium bromide aerosol on respiratory function in patients under ventilator treatment

Abstract

Twenty patients, 36-78 years old, with a history of chronic obstructive lung disease, and immediately after operation mostly for cardiac disease, were treated with ipratropium bromide (IB, 15 cases) or placebo (5 cases). A metered dose inhaler with a new adapter was used during postoperative ventilator treatment. In the IB group the heart rate did not change, but the inspiratory resistance decreased and the arterial oxygen tension increased. This is considered to indicate an effect not only on large but also on small airways, or an improvement of the ventilation/perfusion relationship. The investigation also demonstrated the practical usefulness of the new adapter.

Inhaled Bronchodilator Therapy in Mechanically Ventilated Patients

“…In contrast, the efficacy of aerosol delivery with an MDI in mechanically ventilated patients has had a checkered history. Early studies showed promising results (40,(44)(45)(46). In subsequent studies, different dosages of bronchodilators and different techniques of administration were used to evaluate the efficacy of MDIs in mechanically ventilated patients, leading to variable and often contradictory results (Table 1).…”

“…Both inhaled beta-adrenergic (2, 4-6, 48, 55) and anticholinergic bronchodilators (40,42) are effective in mechanically ventilated patients. Among the sympathomimetic drugs, inhaled isoproterenol hydrochloride (44,45), isoetharine mesylate (46), metaproterenol sulfate (48), fenoterol (41), and albuterol (2, 4-6, 42, 55) all produce significant bronchodilation.…”

Inhalation Therapy in Patients Receiving Mechanical Ventilation: An Update

“…The goals of bronchodilator therapy are to reverse bronchoconstriction, decrease the work of breathing, and/or relieve dyspnea. Administration of either aerosolized b-adrenergic (26,29,(74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88)(89)(90)(91)(92)(93) or anticholinergic drugs (77,79,83,86) produces significant bronchodilator responses in ventilated patients. The combination of fenoterol and ipratropium bromide was found more effective than ipratropium alone in ventilated patients with COPD.…”

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

“…Few investigators have examined the efficacy of bronchodilators in mechanically-ventilated patients [8,11,12,15,[38][39][40][41][42][43][44]. Early studies showed promising results following bronchodilator administration by a MDI [42][43][44], and yet the data were ignored for several years. During that hiatus, adapters to connect a MDI to the ventilator circuit became commercially available.…”