Inhaled Bronchodilator Therapy in Mechanically Ventilated Patients

Dhand, Rajiv; Tobin, Martin J.

doi:10.1164/ajrccm.156.1.9610025

Cited by 172 publications

(152 citation statements)

References 75 publications

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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: 39%

“…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.…”

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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: 39%

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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“…(1) There is now a better understanding of conditions required to reach the deep lung during mechanical ventilation. 9,10 (2) Studies in experimental models of inoculation pneumonia have defined the rationale for comparing intravenous and inhaled dose and have shown much higher lung tissue antibiotic concentrations and higher bactericidal activity for antibiotics administered by nebulization. 11 (3) Technology has evolved for new generation devices, which have shown their ability to generate mass median aerodynamic diameter of Ͻ5 m, a condition required to reach the infected lung parenchyma.…”

Section: See the Related Editorial On Page 1131mentioning

confidence: 99%

Intratracheal Administration of Antimicrobial Agents in Mechanically Ventilated Adults: An International Survey on Delivery Practices and Safety

et al. 2016

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BACKGROUND: Intratracheal antibiotic administration is increasingly used for treating respiratory infections. Limited information is available on delivery devices, techniques, and safety. METHODS: An online survey on intratracheal administration of anti-infective agents in mechanically ventilated adults was answered by health-care workers from 192 ICUs to assess the most commonly used devices, current delivery practices, and safety issues. We investigated whether ICU usage experience (>3 y) impacted its performance. RESULTS: Intratracheal antibiotic administration was a current practice in 87 ICUs (45.3%), with 40 (46%) having experience with the technique (>3 y). Sixty-six (78.6%) of 84 health-care workers reported avoiding intratracheal antibiotic administration due to an absence of evidence-based guidelines (78.6%). Jet nebulizers were the most commonly used devices for delivery, in 24 less experienced ICUs (27.6%) and in 18 (20.7%) experienced ICUs. Direct tracheal instillation (6; 6.9%) was still considered for drug prescription in 12 ICUs (6.9%). More experience resulted in neither greater adherence to measures improving the drug's delivery efficiency (93 measures in the experienced group; 27.9%) nor a greater adoption of measures to increase safety. Indeed, the expiratory filter was changed after each nebulization in only 2 experienced ICUs (6.9%), whereas 15 (51.7%) changed it daily instead. CONCLUSIONS: Intratracheal antibiotic administration is a common therapeutic modality in ICUs, but inadequate practices were widely encountered, independent of the level of experience with the technique. This suggests a need to develop standardization to reduce variability and improve safety and efficacy.

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“…However, providing effective aerosol therapy is a complex procedure that is influenced by many factors. [1][2][3][4][5] Achieving success in aerosol therapy in patients with artificial air-ways depends on both the efficiency of aerosol devices and the type of artificial airways used.…”

Section: Introductionmentioning

confidence: 99%

Pressurized Metered-Dose Inhalers Versus Nebulizers in the Treatment of Mechanically Ventilated Subjects With Artificial Airways: An In Vitro Study

et al. 2015

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A jet nebulizer and pressurized metered-dose inhaler (pMDI) were placed in the inspiratory limb of the circuit 15 cm from the Y-adapter. The jet nebulizer was operated at 8 L/min to deliver albuterol sulfate (2.5 mg/3 mL), whereas an albuterol pMDI was actuated 4 times with a spacer. Drug was eluted from the filter and analyzed by spectrophotometry. RESULTS: Drug delivered via a TT was marginally greater compared with an ETT using the jet nebulizer and pMDI (P ‫؍‬ .10 and .046, respectively). Although delivery efficiency with the pMDI was 3-fold greater than with the jet nebulizer with both a TT and an ETT (P ‫؍‬ .001 and .002, respectively), the jet nebulizer delivered greater drug mass compared with the pMDI with either a TT (P ‫؍‬ .01) or an ETT (P ‫؍‬ .005). CONCLUSIONS: Aerosol drug delivery via a TT was greater than with an ETT, whereas the delivery efficiency of a pMDI via either airway was greater than that of a jet nebulizer.

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Inhaled Bronchodilator Therapy in Mechanically Ventilated Patients

Cited by 172 publications

References 75 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

Intratracheal Administration of Antimicrobial Agents in Mechanically Ventilated Adults: An International Survey on Delivery Practices and Safety

Pressurized Metered-Dose Inhalers Versus Nebulizers in the Treatment of Mechanically Ventilated Subjects With Artificial Airways: An In Vitro Study

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