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Metered-dose inhaler versus nebulized albuterol in mechanically ventilated patients.
Am Rev Respir Dis. 1993 Dec; 148(6 Pt 1):1567-70.AR

Abstract

In nonintubated patients, beta 2-agonist bronchodilators are equally effective when delivered by metered-dose inhalers (MDI) or nebulizers (NEB). The delivery of these drugs by MDI to intubated, mechanically ventilated patients has become a widespread practice. To compare the efficacy of the two delivery systems and establish optimal dosing, we prospectively randomized 10 mechanically ventilated patients, with increased airways resistance, to receive albuterol by either MDI or nebulizer in incrementally higher doses. After a 4-hr washout, patients were crossed-over to receive the drug by the alternative route of administration. Albuterol delivered by NEB to a total dose of 2.5 mg reduced the inspiratory flow-resistive pressure (peak-pause airway pressures) from 21.5 +/- 5.7 to 17.6 +/- 5.4 cm H2O (p < 0.01). Nebulized albuterol at cumulative doses of 7.5 mg led to further reductions in 8 of 10 patients (p < 0.1), but led to toxic side effects in 4 of them; in the remaining 6 patients toxicity occurred at a cumulative dose of 15.0 mg. By contrast, albuterol in cumulative doses reaching 100 puffs (9 mg) from an MDI administered into an endotracheal tube adapter did not significantly reduce resistive pressures, and produced no toxicity. We conclude that nebulized albuterol provides objective physiologic improvement, while albuterol administered by MDI through an endotracheal tube adapter has no effect in mechanically ventilated patients with airflow obstruction. Nebulizer treatments can and should be titrated to higher-than-conventional doses, using toxic side-effects and physiologic response to guide therapy.

Authors+Show Affiliations

Department of Internal Medicine, University of Chicago, Illinois.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

8256902

Citation

Manthous, C A., et al. "Metered-dose Inhaler Versus Nebulized Albuterol in Mechanically Ventilated Patients." The American Review of Respiratory Disease, vol. 148, no. 6 Pt 1, 1993, pp. 1567-70.
Manthous CA, Hall JB, Schmidt GA, et al. Metered-dose inhaler versus nebulized albuterol in mechanically ventilated patients. Am Rev Respir Dis. 1993;148(6 Pt 1):1567-70.
Manthous, C. A., Hall, J. B., Schmidt, G. A., & Wood, L. D. (1993). Metered-dose inhaler versus nebulized albuterol in mechanically ventilated patients. The American Review of Respiratory Disease, 148(6 Pt 1), 1567-70.
Manthous CA, et al. Metered-dose Inhaler Versus Nebulized Albuterol in Mechanically Ventilated Patients. Am Rev Respir Dis. 1993;148(6 Pt 1):1567-70. PubMed PMID: 8256902.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Metered-dose inhaler versus nebulized albuterol in mechanically ventilated patients. AU - Manthous,C A, AU - Hall,J B, AU - Schmidt,G A, AU - Wood,L D, PY - 1993/12/1/pubmed PY - 1993/12/1/medline PY - 1993/12/1/entrez SP - 1567 EP - 70 JF - The American review of respiratory disease JO - Am Rev Respir Dis VL - 148 IS - 6 Pt 1 N2 - In nonintubated patients, beta 2-agonist bronchodilators are equally effective when delivered by metered-dose inhalers (MDI) or nebulizers (NEB). The delivery of these drugs by MDI to intubated, mechanically ventilated patients has become a widespread practice. To compare the efficacy of the two delivery systems and establish optimal dosing, we prospectively randomized 10 mechanically ventilated patients, with increased airways resistance, to receive albuterol by either MDI or nebulizer in incrementally higher doses. After a 4-hr washout, patients were crossed-over to receive the drug by the alternative route of administration. Albuterol delivered by NEB to a total dose of 2.5 mg reduced the inspiratory flow-resistive pressure (peak-pause airway pressures) from 21.5 +/- 5.7 to 17.6 +/- 5.4 cm H2O (p < 0.01). Nebulized albuterol at cumulative doses of 7.5 mg led to further reductions in 8 of 10 patients (p < 0.1), but led to toxic side effects in 4 of them; in the remaining 6 patients toxicity occurred at a cumulative dose of 15.0 mg. By contrast, albuterol in cumulative doses reaching 100 puffs (9 mg) from an MDI administered into an endotracheal tube adapter did not significantly reduce resistive pressures, and produced no toxicity. We conclude that nebulized albuterol provides objective physiologic improvement, while albuterol administered by MDI through an endotracheal tube adapter has no effect in mechanically ventilated patients with airflow obstruction. Nebulizer treatments can and should be titrated to higher-than-conventional doses, using toxic side-effects and physiologic response to guide therapy. SN - 0003-0805 UR - https://www.unboundmedicine.com/medline/citation/8256902/Metered-dose_inhaler_versus_nebulized_albuterol_in_mechanically_ventilated_patients. L2 - https://www.atsjournals.org/doi/10.1164/ajrccm/148.6_Pt_1.1567?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -