R Dhand, AG Duarte, A Jubran, JW Jenne, JB Fink, PJ Fahey and MJ Tobin
Division of Pulmonary and Critical Care Medicine, Edward Hines Jr. Veterans Affairs Hospital, Loyola University of Chicago Stritch School of Medicine, Hines, IL 60141, USA.

In nonintubated patients, metered-dose inhalers (MDIs) are accepted as the most convenient, efficient, and cost effective method of administering inhaled bronchodilators. Recent studies have demonstrated the efficacy of MDIs in ventilator-supported patients; however, the optimal dose of a bronchodilator from a MDI is unknown. We determined the response to increasing doses of albuterol administered by a MDI and cylindrical spacer to 12 mechanically ventilated patients with chronic obstructive pulmonary disease (COPD). Four, eight, and 16 puffs of albuterol were given at 15-min intervals. Rapid airway occlusion were performed before and at 5-min intervals after albuterol for 80 min. Respiratory mechanics were also measured for 60 min in another group of seven patients with COPD who received four puffs of albuterol. Significant decrease in airways resistance occurred after administration of albuterol (p < 0.001). The decrease in airway resistance with four puffs of albuterol was comparable to that observed with cumulative doses of 12 puffs (p = 0.12) and 28 puffs (p = 0.25). Heart rate increased significantly (p < 0.01) after a cumulative dose of 28 puffs. The decrease in airway resistance was sustained for 60 min in the group that received only four puffs of albuterol (p < 0.003). In conclusion, four puffs of albuterol given by a MDI and spacer provided the best combination of bronchodilator effect and safety in stable mechanically ventilated patients with COPD.

This article has been cited by other articles:

				B. Schonhofer and S. Sortor-Leger Equipment needs for noninvasive mechanical ventilation Eur. Respir. J., October 1, 2002; 20(4): 1029 - 1036. [Abstract] [Full Text] [PDF]

				S S Garner, D B Wiest, J W Bradley, and D M Habib Two administration methods for inhaled salbutamol in intubated patients Arch. Dis. Child., July 1, 2002; 87(1): 49 - 53. [Abstract] [Full Text] [PDF]

				S. Nava and M. L. Compagnoni Controlled Short-term Trial of Fluticasone Propionate in Ventilator-Dependent Patients With COPD Chest, October 1, 2000; 118(4): 990 - 999. [Abstract] [Full Text] [PDF]

				A. Jubran Advances in Respiratory Monitoring During Mechanical Ventilation Chest, November 1, 1999; 116(5): 1416 - 1425. [Abstract] [Full Text] [PDF]

				M. A. Jantz and N. A. Collop Bronchodilator Aerosol Delivery in Mechanical Ventilation: Jantz MA, Collop NA Bronchodilator Aerosol Delivery in Mechanical Ventilation Intensive Care Med 1999,14 166-183 J Intensive Care Med, July 1, 1999; 14(4): 166 - 183. [PDF]

				P. Marik, J. Hogan, and J. Krikorian A Comparison of Bronchodilator Therapy Delivered by Nebulization and Metered-Dose Inhaler in Mechanically Ventilated Patients Chest, June 1, 1999; 115(6): 1653 - 1657. [Abstract] [Full Text] [PDF]

				G. C. Smaldone Aerosolized Bronchodilators in the Intensive Care Unit . Much Ado about Nothing? Am. J. Respir. Crit. Care Med., April 1, 1999; 159(4): 1029 - 1030. [Full Text] [PDF]

				C. GUERIN, A. CHEVRE, P. DESSIRIER, T. PONCET, M.-H. BECQUEMIN, P. F. DEQUIN, C. LE GUELLEC, D. JACQUES, and G. FOURNIER Inhaled Fenoterol-Ipratropium Bromide in Mechanically Ventilated Patients with Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., April 1, 1999; 159(4): 1036 - 1042. [Abstract] [Full Text] [PDF]

				J. B. FINK, R. DHAND, J. GRYCHOWSKI, P. J. FAHEY, and M. J. TOBIN Reconciling In Vitro and In Vivo Measurements of Aerosol Delivery from a Metered-Dose Inhaler during Mechanical Ventilation and Defining Efficiency-enhancing Factors Am. J. Respir. Crit. Care Med., January 1, 1999; 159(1): 63 - 68. [Abstract] [Full Text]

				R. DHAND and M. J. TOBIN Inhaled Bronchodilator Therapy in Mechanically Ventilated Patients Am. J. Respir. Crit. Care Med., July 1, 1997; 156(1): 3 - 10. [Full Text]