Inhaled beta2-agonists for asthma in mechanically ventilated patients

Jones, Arthur; Rowe, BH; Peters, Jay I.; Camargo, Carlos A.; Hammarquist, Cecilia

doi:10.1002/14651858.cd001493

Cited by 10 publications

(7 citation statements)

References 15 publications

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“…The evidence for inhaled medications in children presented in this review are summarised in Table . Despite the widespread use of bronchodilator therapy in patients whose tracheas are intubated, a Cochrane review found no satisfactory clinical trials had been conducted on the use of bronchodilators in intubated and mechanically ventilated patients . Another review of critically ill adults requiring tracheal intubation and bronchodilator therapy concluded that there was insufficient evidence to promote the use of nebulisers or pMDIs for drug administration in ventilated adult patients .…”

Section: Resultsmentioning

confidence: 99%

Current options in aerosolised drug therapy for children receiving respiratory support

et al. 2017

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Inhalation of aerosolised medications are the mainstay of treatment for a number of chronic lung diseases and have several advantages over systemically-administered medications. These include more rapid onset of action for drugs such as β-adrenergic agonists when compared with oral medication, high luminal doses for inhaled antibiotics when used to treat endobronchial infection, and an improved therapeutic index compared with systemic delivery for these and other classes of drugs such as corticosteroids. The use of aerosolised drugs to treat patients whose tracheas are intubated is less well established, in part because systemic delivery via the intravenous route can be a simpler alternative for many drugs. Consequently, research in this area is largely limited to a number of in vitro studies and very few clinical trials. Unfortunately, a lack of focus in this area has resulted in a number of practices which at best are ineffective, and at worst dangerous for the patient. Although there have been some attempts to re-invigorate research in order to improve delivery systems, current devices are, to a great extent, based on long-standing technology developed more than 50 years ago. In this review, we explore current knowledge and provide guidance as to when and how the inhaled route may be of value when treating patients whose tracheas are intubated, and we set out the challenges facing those attempting to advance the topic. We conclude by reviewing current areas of interest that may lead to more effective and widespread use of aerosols in the treatment of intubated patients.

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Section: Resultsmentioning

confidence: 99%

Current options in aerosolised drug therapy for children receiving respiratory support

et al. 2017

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“…37,38,[41][42][43][44][45][46][47] This can usually be achieved with benzodiazepines combined with opioids, or propofol. [48][49][50] Ketamine is an attractive agent because of its bronchodilating properties; however, its psychotropic and sympathomimetic actions are major limitations. Trials in nonintubated patients with severe exacerbations have not shown clinical benefit.…”

Section: Treatment Of Acute Asthma In the Intensive Care Unitmentioning

confidence: 99%

“…Factors related to the endotracheal tube, the ventilator circuit, the ventilatory pattern and settings, and the patient-ventilator interface may reduce aerosol deposition in the lower airway to as low as 5%, and higher doses must be used. [45][46][47][48] MDIs are the preferred route of administration. 47,48 Intubation and mechanical ventilation are not without problems.…”

Section: Treatment Of Acute Asthma In the Intensive Care Unitmentioning

confidence: 99%

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How Should Acute Severe Asthma Be Managed in the Intensive Care Unit?

Warren¹,

McFadden²

2010

Evidence-Based Practice of Critical Care

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“…A recent Cochrane review of the comparison of nebulized salbutamol in the ventilated patient concluded that evidence was lacking for or against either technique and that further studies are required. 9 Adrenaline has also been used as a nebulized beta-agonist, but there is no evidence that it is superior to salbutamol for treating bronchospasm and may be associated with more adverse effects.…”

Section: Management Of Bronchospasm Beta 2 -Agonistsmentioning

confidence: 99%

Critical care clinical conundrums

Pouchet

2004

Clinical Intensive Care

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A 50-year-old postman was admitted to the Accident and Emergency (A&E) department as a trauma call. He had been found unconscious at the side of the road with his mangled bicycle nearby. Passersby noticed he had been wobbling on his cycle prior to his event, but no one had seen him fall. On admission, he had a Glasgow coma score of 3/15 with pinpoint pupils, profound hypotension and tachycardia. He was intubated and ventilated, and 2 l of warmed Hartmann's solution were administered rapidly intravenously. During the secondary survey, he was reviewed by the intensive care consultant, who noticed that he was very hot, dehydrated and vasodilated. His tympanic temperature was 41.28C. As it was one of the hottest days in the hottest summer of many years, a presumptive diagnosis of heat stroke was made. Immediate cooling measures were instituted and the warmed fluid changed to cold colloid. He was noticeably bleeding from all puncture sites and fresh frozen plasma (FFP) was ordered. He was taken quickly to the intensive care unit after a computerized tomography (CT) scan of the brain, which demonstrated no abnormalities.

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Inhaled beta2-agonists for asthma in mechanically ventilated patients

Cited by 10 publications

References 15 publications

Current options in aerosolised drug therapy for children receiving respiratory support

Current options in aerosolised drug therapy for children receiving respiratory support

How Should Acute Severe Asthma Be Managed in the Intensive Care Unit?

Critical care clinical conundrums

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