Comparison of one versus two bronchodilators in ventilated COPD patients

Fernández, Alejandro; Muñoz, J García-Arroba; Calle, B. de la; Alía, Inmaculada; Ezpeleta, A.I.; Cal, Miguel A. de la; Reyes, A.

doi:10.1007/bf01704700

Cited by 45 publications

(31 citation statements)

References 21 publications

(17 reference statements)

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“…A decrease in values of Rrs,max and Rrs,min occurs following bronchodilator administration in mechanicallyventilated patients [11,12,39,41,50].…”

Section: Assessment Of the Bronchodilator Responsementioning

confidence: 98%

“…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.…”

Section: Efficacy Of Bronchodilator Administered By a MDI In Mechanicmentioning

confidence: 99%

“…The potential for atrial and ventricular arrhythmias must be borne in mind when high doses of beta-agonists are given in critically ill patients [60,61]. Although most studies have reported no adverse effects following administration of albuterol with a MDI to mechanically-ventilated patients [8,10,11,[38][39][40][41], we observed a dose-dependent increase in heart rate, becoming significant after administration of a cumulative dose of 28 puffs [12]. CFCs, used as propellants in a MDI, have a short half-life (<40 s) in blood after administration of a MDI to healthy volunteers.…”

Section: Toxicity Of Drugs Administered With a MDI In Mechanically-vementioning

confidence: 99%

See 2 more Smart Citations

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

Dhand¹,

Tobin²

1996

Eur Respir J

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“…A decrease in values of Rrs,max and Rrs,min occurs following bronchodilator administration in mechanicallyventilated patients [11,12,39,41,50].…”

Section: Assessment Of the Bronchodilator Responsementioning

confidence: 98%

Section: Efficacy Of Bronchodilator Administered By a MDI In Mechanicmentioning

confidence: 99%

Section: Toxicity Of Drugs Administered With a MDI In Mechanically-vementioning

confidence: 99%

See 1 more Smart Citation

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

Dhand¹,

Tobin²

1996

Eur Respir J

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“…The combination of fenoterol and ipratropium bromide was found more effective than ipratropium alone in ventilated patients with COPD. (94) Combinations of inhaled corticosteroids (ICS) plus longacting b-agonist (LABA) (Advair, GSK, Research Triangle Park, NC; Symbicort Astra Zeneca, Wilmington, DE) are among the most effective and widely used treatments currently available for treatment of asthma. A combination of formoterol and budesonide used as a reliever as well as maintenance therapy may be employed for treatment of mild to moderate acute asthma exacerbations that could be managed at home.…”

Section: Bronchodilator Therapymentioning

confidence: 99%

Inhalation Therapy in Patients Receiving Mechanical Ventilation: An Update

Ari

Fink

Dhand

2012

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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Incremental gains in understanding the influence of various factors on aerosol delivery in concert with technological advancements over the past 2 decades have fueled an ever burgeoning literature on aerosol therapy during mechanical ventilation. In-line use of pressurized metered-dose inhalers (pMDIs) and nebulizers is influenced by a host of factors, some of which are unique to ventilator-supported patients. This article reviews the impact of various factors on aerosol delivery with pMDIs and nebulizers, and elucidates the correlation between in-vitro estimates and in-vivo measurement of aerosol deposition in the lung. Aerosolized bronchodilator therapy with pMDIs and nebulizers is commonly employed in intensive care units (ICUs), and bronchodilators are among the most frequently used therapies in mechanically ventilated patients. The use of inhaled bronchodilators is not restricted to mechanically ventilated patients with chronic obstructive pulmonary disease (COPD) and asthma, as they are routinely employed in other ventilator-dependent patients without confirmed airflow obstruction. The efficacy and safety of bronchodilator therapy has generated a great deal of interest in employing other inhaled therapies, such as surfactant, antibiotics, prostacyclins, diuretics, anticoagulants and mucoactive agents, among others, in attempts to improve outcomes in critically ill ICU patients receiving mechanical ventilation.

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“…Their use is recommended in COPD patients suffering from daily symptoms [73,74]. In ventilator-dependent patients, the combination of a β 2 -agonist with an anticholinergic was more effective than an anticholinergic alone to decrease airflow resistance [75].…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

Pulmonary hyperinflation and ventilator-dependent patients

Rossi¹,

Ganassini²,

Polese³

et al. 1997

Eur Respir J

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Pulmonary hyperinflation is a major medical problem in patients with advanced chronic obstructive pulmonary disease (COPD) or acute asthma. The apparent beneficial effects of pulmonary hyperinflation on lung mechanics, such as an increased airway patency and lung elastic recoil, are by far overwhelmed by the deleterious effects on the pressure generating capacity of the respiratory muscles. Moreover, the ventilatory workload can be remarkably increased: 1) by the displacement of the respiratory system toward the upper, flat portion of the pressure-volume curve; 2) by the need to expand the chest wall and not only the lungs; and 3) by the intrinsic positive end-expiratory pressure (PEEPi) systematically associated with dynamic hyperinflation.In mechanically ventilated patients, the mechanisms underlying pulmonary hyperinflation as well as its pathophysiological consequences do not differ from those described in spontaneously breathing patients. However, there are some specific issues that should be taken into account, namely the effect of the endotracheal tube and the mode and setting of the ventilator. In mechanically ventilated patients, pulmonary hyperinflation increases the risk of barotrauma and may hamper weaning due to the excessive burden of PEEPi, which can even lead to ineffective inspiratory efforts.Because of its harmful consequences, pulmonary hyperinflation must be treated aggressively by pharmacological therapy and, when needed, by ventilatory treatment. The setting of the ventilator must be predetermined to ensure the longest possible time for expiration, and positive end-expiratory pressure can be applied to prevent an excessive workload for the patient and ineffective inspiratory efforts.

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Comparison of one versus two bronchodilators in ventilated COPD patients

Abstract: The combination of both drugs is more effective than ipratropium bromide alone at the doses used in this study.

Cited by 45 publications

References 21 publications

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

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

Inhalation Therapy in Patients Receiving Mechanical Ventilation: An Update

Pulmonary hyperinflation and ventilator-dependent patients

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