Effect of salmeterol/fluticasone combination on the dynamic changes of lung mechanics in mechanically ventilated COPD patients: a prospective pilot study

Abstract

BackgroundThe combined therapy of inhaled corticosteroids and long-acting beta-2 agonists for mechanically ventilated patients with COPD has never been explored. Therefore, the aim of this study was to investigate their dynamic effects on lung mechanics and gas exchange.Materials and methodsTen mechanically ventilated patients with resolution of the causes of acute exacerbations of COPD were included. Four puffs of salmeterol 25 μg/fluticasone 125 μg combination therapy were administered. Lung mechanics, including maximum resistance of the respiratory system (Rrs), end-inspiratory static compliance, peak inspiratory pressure (PIP), plateau pressure, and mean airway pressure along with gas exchange function were measured and analyzed.ResultsSalmeterol/fluticasone produced a significant improvement in Rrs and PIP after 30 minutes. With regard to changes in baseline values, salmeterol/fluticasone inhalation had a greater effect on PIP than Rrs. However, the therapeutic effects seemed to lose significance after 3 hours of inhaled corticosteroid/long-acting beta-2 agonist administration.ConclusionThe combination of salmeterol/fluticasone-inhaled therapy in mechanically ventilated patients with COPD had a significant benefit in reducing Rrs and PIP.

Effect of Tiotropium Soft Mist Inhalers on Dynamic Changes in Lung Mechanics of Patients with Chronic Obstructive Pulmonary Disease Receiving Mechanical Ventilation: A Prospective Pilot Study

“…However, the decreased values gradually returned to the baseline values after the 6 h time point. This finding is the same as that in our previous study evaluating the effects of salmeterol and fluticasone on lung mechanics in patients receiving mechanical ventilation, which revealed that salmeterol has the maximum bronchodilation effect, causing 15% lower PIP than the baseline value [ 23 ]. Malliotakis et al evaluated the duration of salmeterol-induced bronchodilation and noted that salmeterol led to an approximately 10% reduction in PIP at 2 to 6 h but that the PIP gradually returned to the baseline after the 6 h time point [ 7 , 30 ].…”

“…Malliotakis et al evaluated the duration of salmeterol-induced bronchodilation and noted that salmeterol led to an approximately 10% reduction in PIP at 2 to 6 h but that the PIP gradually returned to the baseline after the 6 h time point [ 7 , 30 ]. Other major parameters evaluated in the current study—such as Pmean, Pplat, and Rrs—reached their minimum at 6 h after tiotropium SMI actuation but had returned to the baseline value by 12 h. The greatest change was observed in Rrs, which was decreased by approximately 13% at 6 h. The poor performance of long-acting bronchodilators in mechanically ventilated patients compared with that in spontaneously breathing patients may be due to multiple factors such as use of a chamber with MDIs, connection of the inhalation device to the inspiratory line at 10–30 cm from the endotracheal tube, humidity in the ventilator circuit, the tidal volume setting, the inspiration flow rate, the respiratory frequency, and use of a breath-holding maneuver after inhalation [ 5 , 23 , 29 ]. Although several studies have measured lung mechanics after administering long-acting bronchodilators [ 5 , 16 , 17 , 23 , 30 , 31 ], our findings imply that the dose to the patients with COPD receiving mechanical ventilation was insufficient due to the limitations of the mechanical ventilated circuit and setting.…”

“…The tiotropium SMI was connected to the ventilator circuit at 15 cm from the Y-piece with a T-adaptor, as reported [ 16 , 17 ]. After two puff of Tiotropium SMI actuation was performed at the initiation of the inspiration phase of the volume control mode, the lung mechanism will be checked according to the time points of protocol at 1 h, 3 h, 6 h, 12 h, and 24 h. To maintain airway hygiene and oxygenation (FiO 2 = 1.0), an open method of sputum suction was performed at least 5 min before initiation of the protocol and before each measurement, as described in our previous report [ 23 ]. The 5-min interval was sufficient to prevent transient bronchoconstriction after sputum suction [ 24 ].…”

Comparison of Inspiratory Effort, Workload and Cycling Synchronization Between Non-Invasive Proportional-Assist Ventilation and Pressure-Support Ventilation Using Different Models of Respiratory Mechanics

“…The Rrs and Crs values used for the four respiratory mechanics profiles (obstructive, mildly restrictive, severely restrictive and mixed obstructive/restrictive) in this study were based on previously published data. For example, Salihoglu et al reported dynamic respiratory compliance (Cdyn) and airway resistance (Raw) of 40±8 mL/cmH 2 O and 19±4 cmH 2 O/L/s, respectively, in intubated patients with COPD in the supine position [36]. In 10 mechanically ventilated patients with acute exacerbations of COPD, Chen et al determined Raw and Crs to be 17.4±7.6 cmH 2 O/L/s and 46.0±23.6 mL/cmH 2 O, respectively [37].…”

How Should Aerosols Be Delivered During Invasive Mechanical Ventilation?

“…In patients receiving long-term ventilation for severe COPD, Nava and Compagnoni observed a small but statistically significant reduction in airway resistance with fluticasone. 169 A combination of salmeterol and fluticasone administered to mechanically ventilated patients by pMDI (4 doses) reportedly reduced inspiratory resistance, 170 but this effect was probably because of the salmeterol component in the combination. Despite the lack of studies showing efficacy of ICS in the setting of mechanical ventilation, the majority of respondents reported employing inhaled budesonide or methylprednisolone in international surveys.…”