RESPIRATORY RESPONSE TO SALBUTAMOL (ALBUTEROL) IN VENTILATOR-DEPENDENT INFANTS WITH CHRONIC LUNG-DISEASE - PRESSURIZED AEROSOL DELIVERY VERSUS INTRAVENOUS-INJECTION

Objective: To compare the effects of intravenously injected with inhal ed salbutamol in ventilator dependent infants with chronic lung diseas e (CLD). Design: Prospective randomized study in which each patient se rved as his/her own control. Setting: Multidisciplinary neonatal and p ediatric ICU. Patients: 8 ventilator dependent premature infants with CLD. Interventions: Salbutamol, 10 mug/kg was given intravenously, and 10-19 h later, twice 100 mug as pressurized aerosol, or vice versa, s equence randomized. The pressurized aerosol was delivered by a metered dose inhaler into a newly developed aerosol holding chamber, integrat ed into the inspiratory limb of the patient circuit. Respiratory syste m mechanics were assessed by the single breath occlusion method before and 10 and 60 min after drug administration. Measurements and results : Compliance improved significantly after intravenous injection (0.48/-0.18 to 0.67+/-0.16, p<0.01 and 0.59+/-0.23 ml/cmH2O/kg, NS, (mean+/ -1 SD) and after inhalation (0.46+/-0.19 to 0.64+/-0.32, p<0.01 and 0. 56+/-0.31 ml/cmH2O/kg, NS). Resistance decreased after iv. use (0.38+/ -0.17 to 0.25+/-0.11, p<0.001 and 0.25+/-0.10 cmH2O/ml/s, NS) and afte r inhalation (0.35+/-0.12 to 0.27+/-0.09, p<0.01 and 0.28+/-0.12 cmH2O /ml/s, NS). Heart rate increased significantly after both routes of ap plication, whereas mean arterial pressure, respirator settings, FIO2, transcutaneous SO2 and capillary PCO2 did not change. Conclusions: Inh aled and intravenous salbutamol improves pulmonary mechanics to the sa me extent with comparable side effects, and may therefore be used to f acilitate weaning from respirators.