Bronchodilator delivery by metered-dose inhaler in mechanically ventilated COPD patients: influence of tidal volume

Mouloudi, Eleni; Katsanoulas, Konstantinos; Anastasaki, Maria; Höing, S.; Georgopoulos, Dimitris

doi:10.1007/s001340051049

Cited by 39 publications

(41 citation statements)

References 19 publications

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“…It was further shown that the response was evident even when salbutamol was given in relatively low doses and not influenced by the inspiratory flow/time profile during drug delivery. Independent of the dose of salbutamol, DR remained relatively constant throughout the study, indicating that salbutamol acted by dilating the central airways, in line with previous observations [3,13,14]. Although expiratory resistance was not measured in the present study, it was most probably decreased by salbutamol, as indicated by the significant reduction in PEEPi and end-inspiratory static plateau pressure, indirect indices of dynamic hyperinflation.…”

Section: Discussionsupporting

confidence: 91%

“…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%

“…These suggestions, however, are based on in vitro studies using models of mechanical ventilation. Indeed it was recently demonstrated in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD) that application of an end-inspiratory pause time of 5 s or a 50% increase in VT when bronchodilators were administered in adequate doses did not have any additional bronchodilator effect [13,14]. These studies raise the issue that ventilator settings may not be a critical factor in bronchodilation.…”

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: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 39%

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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“…12,13 This information led to the practice of increasing V T or providing sigh breaths during nebulization. 2 Previous research using a pediatric model of mechanical ventilation with a jet nebulizer, 6 and a clinical study in adults, 14 had opposite findings. We hypothesized that increasing the V T , using a vibrating mesh nebulizer, and placing the nebulizer at the ventilator would increase lung dose and drug delivery efficiency in a pediatric model of mechanical ventilation.…”

Section: Introductionmentioning

confidence: 98%

Effect of Tidal Volume and Nebulizer Type and Position on Albuterol Delivery in a Pediatric Model of Mechanical Ventilation

Berlinski

Willis

2015

Respir Care

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BACKGROUND: Optimization of factors affecting aerosol delivery during mechanical ventilation in the pediatric population is important. We hypothesized that increasing the tidal volume (V T ), using a vibrating mesh nebulizer, and placing the nebulizer at the ventilator would increase lung dose/delivery efficiency. METHODS: Continuous-output jet and vibrating mesh nebulizers loaded with albuterol (2.5 mg/3 mL) were compared when placed before the Y-piece and at the ventilator.

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“…As expected, albuterol decreased the minimum and maximum end-inspiratory R RS ) in mechanically ventilated patients with COPD exacerbation, in agreement with previous studies. 2,4,13 Nonetheless, both with and without albuterol, expiratory resistance at the beginning of expiration was approximately 85% higher than end-inspiratory resistance, and increased more than 3-fold toward the end of expiration. Albuterol-induced decrease in expiratory resistance was greater toward the end of expiration.…”

Section: Discussionmentioning

confidence: 93%

Effect of Albuterol on Expiratory Resistance in Mechanically Ventilated Patients

et al. 2011

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Bronchodilator delivery by metered-dose inhaler in mechanically ventilated COPD patients: influence of tidal volume

Cited by 39 publications

References 19 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

Effect of Tidal Volume and Nebulizer Type and Position on Albuterol Delivery in a Pediatric Model of Mechanical Ventilation

Effect of Albuterol on Expiratory Resistance in Mechanically Ventilated Patients

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