Two administration methods for inhaled salbutamol in intubated patients

Abstract

Aims: To compare serum concentrations and effects on respiratory mechanics and haemodynamics of salbutamol administered by small volume nebuliser (SVN) and metered dose inhaler (MDI) plus spacer. Methods: Blinded, randomised, crossover study in 12 intubated infants and children (mean age 17.8 months) receiving inhaled salbutamol therapy. Subjects received salbutamol as 0.15 mg/kg by SVN and four puffs (400 µg) by MDI plus spacer at a four hour interval in random order. Passive respiratory mechanics were measured by a single breath/single occlusion technique, and serum salbutamol concentrations by liquid chromatography-mass spectrometry at 30 minutes, 1, 2, and 4 hours after each dose. Haemodynamics (heart rate and blood pressure) were recorded at each measurement time.Results: There was no difference in percentage change in respiratory mechanics or haemodynamics between the two methods of administration. Mean area under the curve (AUC 0-4 ) was 5.86 for MDI plus spacer versus 4.93 ng/ml × h for SVN. Conclusions: Serum concentrations and effects on respiratory mechanics and haemodynamics of salbutamol were comparable with the two administration methods under the conditions studied. Future studies are needed to determine the most effective and safe combination of dose and administration method of inhaled salbutamol in mechanically ventilated infants and children.

Pediatric Aerosol Therapy

“…3). 55 Garner et al 65 reported similar clinical effects and albuterol concentrations in ventilated subjects receiving albuterol therapy via pMDI/spacer (between Y-piece and ETT) and a jet nebulizer placed in the inspiratory limb (10 -20 cm before the Y-piece).…”

Salbutamol Transport and Deposition in the Upper and Lower Airway with Different Devices in Cats: A Computational Fluid Dynamics Approach

“…Other factors that may modify particle lung deposition when using pMDI aerosol in ventilated humans are the ventilator mode, settings, and circuit [ 47 ], and synchronization of pMDI application with breaths, among other factors [ 48 ]. In addition, the therapeutic response may be influenced by the patient’s airway anatomy and disease severity [ 49 ].…”

Inalador dosimetrado com espaçador artesanal versus nebulizador no tratamento da crise de sibilância na criança

“…Wildhaber 27 mostra que o inalador dosimetrado acoplado a dois tipos de espaçadores disponibiliza para inalação uma maior quantidade de partículas (40,2% e 40,7% das partículas geradas) que o nebulizador (25,3%). Os estudos revistos (Tabela 6), que compararam nebulizador com aerossol dosimetrado acoplado a espaçador 14,[18][19][20][21][22][23] , também utilizaram doses diferentes nos dois sistemas inalatórios (4 a 37 vezes maior com o nebulizador, conforme o estudo). Um trabalho em modelo de pulmão neonatal em ventilação mecânica 23 mostrou a equivalência entre 100 µg (através de aerossol dosimetrado com espaçador) e 2.500 a 3.700 µg (através de nebulizador), medindo a quantidade de droga depositada nas vias aéreas inferiores centrais.…”