RT Journal Article
SR Electronic
T1 Bronchodilator delivery with metered-dose inhalers in mechanically-ventilated patients
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 585
OP 595
DO 10.1183/09031936.96.09030585
VO 9
IS 3
A1 R Dhand
A1 MJ Tobin
YR 1996
UL http://erj.ersjournals.com/content/9/3/585.abstract
AB Metered-dose inhalers (MDIs) provide several advantages over nebulizers, including ease of administration, decreased cost, reliability of dosing, and freedom from contamination. However, this method of aerosol delivery has been considered ineffective in mechanically-ventilated patients because most of the aerosol deposits in the endotracheal tube and ventilator circuit. A smaller amount of aerosol from a MDI is deposited in the lower respiratory tract of mechanically-ventilated patients than in ambulatory patients, although recent studies show that a significant bronchodilator effect can still be achieved. When employed optimally, significant bronchodilation occurs with as little as 4 puffs of a sympathomimetic aerosol. Multiple factors influence the efficacy of MDIs in mechanically-ventilated patients. The method of connecting the MDI canister to the ventilator circuit has a marked effect on aerosol delivery, and other factors include the timing of MDI actuation, ventilator mode, tidal volume, circuit humidity, and duty cycle. With a proper technique of administration, a MDI serves as an effective, convenient, and safe method for delivering bronchodilator aerosols in mechanically-ventilated patients.