Document Detail


Bronchodilator delivery by metered-dose inhaler in mechanically ventilated COPD patients: influence of tidal volume.
MedLine Citation:
PMID:  10654204     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The delivery of bronchodilator drugs with metered-dose inhaler (MDI) and a spacer in mechanically ventilated patients has become a widespread practice. However, the various ventilator settings that influence the efficacy of MDI are not well established. The tidal volume (VT) during drug delivery has been suggested as one of the factors that might increase the effectiveness of this therapy. To test this, the effect of two different VT on the bronchodilation induced by beta 2-agonists administered with MDI and a spacer in a group of mechanically ventilated patients with chronic obstructive pulmonary disease (COPD) was examined. METHODS: Nine patients with COPD, mechanically ventilated on volume-controlled mode, were prospectively randomised to receive six puffs of salbutamol (S, 100 micrograms/puff) either with a VT of 8 ml/kg (normal VT, 582 +/- 85) or with a VT of 12 ml/kg (high VT, 912 +/- 137). With both modes inspiratory flow was identical. S was administered with 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 S by the alternative mode of administration. Static and dynamic airway pressures, minimum (Rint) and maximum (Rrs) inspiratory resistance, the difference between Rrs and Rint (delta R), static end-inspiratory respiratory system compliance (Cst,rs), intrinsic positive end-expiratory pressure (PEEPi) and heart rate (HR) were measured before and at 15, 30 and 60 min after S. RESULTS: S caused a significant decrease in dynamic and static airway pressures, PEEPi, Rint and Rrs. These changes were not influenced by VT and were evident at 15, 30 and 60 min after S. With normal and high VT, Cst,rs, delta R and HR did not change after S. CONCLUSIONS: We conclude that S delivered with an MDI and a spacer device induces significant bronchodilation in mechanically ventilated patients with COPD, the magnitude of which is not affected by at least a 50% increase in VT. These results do not support the VT manipulations when bronchodilators are administered in adequate doses during controlled mechanical ventilation.
Authors:
E Mouloudi; K Katsanoulas; M Anastasaki; S Hoing; D Georgopoulos
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Intensive care medicine     Volume:  25     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  1999 Nov 
Date Detail:
Created Date:  2000-02-24     Completed Date:  2000-02-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1215-21     Citation Subset:  IM    
Affiliation:
Intensive Care Unit, University Hospital of Heraklion, University of Crete, Greece.
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MeSH Terms
Descriptor/Qualifier:
Administration, Inhalation
Adrenergic beta-Agonists / administration & dosage*
Aged
Airway Resistance / physiology
Albuterol / administration & dosage*
Analysis of Variance
Bronchodilator Agents / administration & dosage*
Cross-Over Studies
Female
Heart Rate / drug effects
Humans
Lung Diseases, Obstructive / drug therapy,  therapy*
Male
Nebulizers and Vaporizers
Positive-Pressure Respiration*
Prospective Studies
Respiratory Mechanics / drug effects
Tidal Volume / physiology
Chemical
Reg. No./Substance:
0/Adrenergic beta-Agonists; 0/Bronchodilator Agents; 18559-94-9/Albuterol
Comments/Corrections
Comment In:
Intensive Care Med. 1999 Nov;25(11):1206-8   [PMID:  10654201 ]

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