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Am. J. Respir. Crit. Care Med., Volume 159, Number 4, April 1999, 1036-1042

Inhaled Fenoterol-Ipratropium Bromide in Mechanically Ventilated Patients with Chronic Obstructive Pulmonary Disease

CLAUDE GUERIN, ARNAUD CHEVRE, PIERRE DESSIRIER, THIERRY PONCET, MARIE-HELENE BECQUEMIN, PIERRE FRANÇOIS DEQUIN, CHANTAL LE GUELLEC, DIDIER JACQUES, and GERARD FOURNIER

Service de Réanimation Médicale, Centre Hospitalier Lyon-Sud, Pierre-Bénite; Service Central d'Explorations Fonctionnelles Respiratoires, Groupe Hospitalier Pitié-Salpétrière, Paris; Groupe de Recherche Epithelium Respiratoire et Inflammation et Service de Réanimation Médicale; and Laboratoire de Pharmacologie et Toxicologie cliniques, CHU Bretonneau, Tours, France

In 18 patients with chronic obstructive pulmonary disease intubated and mechanically ventilated, we prospectively randomized 200 µg fenoterol-80 µg ipratropium bromide (four puffs) from a metered-dose inhaler (MDI) versus 1.25 mg fenoterol-500 µg ipratropium bromide in 5 ml saline from a nebulizer (NEB). Respiratory mechanics were assessed before and 30 min after the end of each delivery by the rapid end-inspiratory airway occlusion technique. We did vary on single breaths the inflation flow (V) from 0.2 to 1.2 L · s-1, at constant inflation volume. The total respiratory resistance of the respiratory system (Rrs) was partitioned into airway (Rint,rs) and tissue (Delta Rrs) resistances. We found that Rrs was equivalently reduced, from 16.49 ± 1.37 to 14.85 ± 1.88 cm H2O · L-1 · s with MDI (p < 0.05) and from 18.04 ± 1.85 to 15.15 ± 1.33 cm H2O · L-1 · s with NEB (p < 0.01). Whereas the prevailing effect of MDI was to reduce Rint,rs, that of NEB was to decrease Delta Rrs. In addition, the V resistance of the respiratory system over the whole range of V was significantly affected by NEB but not by MDI.




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