TREATMENT OF BRONCHOSPASM BY METERED-DOSE INHALER ALBUTEROL IN MECHANICALLY VENTILATED PATIENTS

beta(2)-agonist bronchodilators delivered by metered-dose inhalers (MD I) are commonly used in the treatment of bronchospasm in both intubate d and nonintubated patients. Substantial data support the effectivenes s of MDI delivery systems in nonintubated patients. However, few studi es have examined the effectiveness of MDIs in intubated, mechanically ventilated patients. MDIs are often used in conjunction with a spacing device that may enhance delivery of drug to the airways, but few in v ivo data have demonstrated efficacy of this delivery method in ventila ted patients. We studied ten critically ill patients who had a peak (P -peak) to pause (P-pause) gradient of more than 15 cm H2O during sedat ed, quiet breathing on assist control ventilation. We administered 5, 10, and 15 puffs (90 mu g per puff) of MDI albuterol through a specifi c spacer (Aerovent) at 30-min intervals, while measuring resistive pre ssure (defined as P-peak-P-pause) before and after treatments. Resisti ve airway pressure after 5 puffs decreased in nine of ten patients, fr om 25.1+/-7.2 to 20.8+/-5.6 cm H2O (p<0.12). The addition of 10 more p uffs further reduced resistive pressure in nine of nine patients from 20.8+/-5.6 to 19.0+/-4.4 (p<0.01). Fifteen more puffs (30 cumulative p uffs) did not result in further improvement (p>0.5). A toxic reaction occurred in one patient (systolic blood pressure decreased 20 mm Hg) a fter 5 puffs of albuterol. We conclude that MDI administered through t his specific spacer is effective in mechanically ventilated patients i n doses up to 15 puffs, and that therapy should be titrated to effecti veness and toxicity.