1995 OPEN FORUM Abstracts
BRONCHODILATOR THERAPY THROUGH AIRWAY FOR PATIENTS WITH MECHANICAL VENTILATION: A COMPARISON OF 3 DELIVERY METHODS
Mauo-Ying Bien MS RPT CRTT, Jia-Horng Wang MD, Wun-Hsiu Chen RT, Wun-Jie Hsu RT, Chong-Chen Lu RRT MD. Veterans Gereral Hospital-Taipei, Taiwan, Republic of China
Introduction: Aerosolized bronchodilators are commonly administered to intubated mechanically ventilated patients by using a small volume nebulizer (SVN) or metered dose inhaler (MDI) with spacer. Both methods can get good bronchodilation effects. In our institution, directly instilling bata-agonist into patient's artificial airway (INS) in the emergency condition can also relieve bronchospasm immediately. The purpose of this study was to compare the bronchodilation effects, side effects and cost of these 3 methods to deliver terbutaline in patients with mechanical ventilation.
Methods: Seventeen mechanically ventilated patients (12 males and 5 females, aged 69.76±7.64 yrs) due to acute exacerbation of COPD or asthma, having order to receive terbutaline inhalation for control of bronchospasm, were consented to participate in this study. Method A was to inhale 4 ml (10 mg) of terbutaline by SVN; Method B, 4 puff (1mg) by MDI with Aerovent; and Method C, 4 ml (10 mg) by INS followed by manual hyperinflation. Each patient received 3 methods of treatment on the same day at intervals of at least 4 hours. The sequence of methods was randomized. The ventilator setting was kept the same throughout the study. Respiratory rate, Ppeak, Pplat, auto-PEEP, Rinsp, pulse rate, SaO2 and BS in each patient were monitored before and 0, 30, 60, 120 minutes after each treatment. Arterial blood gas was analyzed 60 minutes after each treatment. The costs of medication, driving gas, device, and manpower per one treatment were estimated in US dollars for each method. Data were expressed as mean (SD). One-way ANOVA for repeated measures and Turkey's Test for multiple comparisons were used to compare the results.
Results: All patients tolerated these 3 methods of treatment well. Significant difference in Rinsp change was found between Methods A and B, A and C (pɘ.05) at 120 minutes after treatment. Significant difference in pulse rate change was found at post-0, 30, 60 and 120 minutes of treatment between Methods A and C, B and C (pɘ.05). No significant difference in Ppeak, Pplat, Auto-PEEP, RR, SBP, DBP, SaO2 and BS at any point of measurement; ABG at post-60 minutes; Rinsp at post-0, 30, 60 minutes was found among these 3 methods. The most cost- saving method is B (US$ 3.03 vs US$ 11.74 in A and US$ 8.54 in C).
Baseline12.99(6.07) 14.02(6.76) 13.31(7.24)
Post- 0min1.72(3.98)-1.87(5.21) 0.90(4.07)
Post- 30min 1.93(5.09)-1.43(5.14) 0.66(3.97)
Post- 60min 0.66(3.94)-1.20(6.31) -0.05(3.96)
Post-120min 2.83(3.84)***-2.48(6.43)* -2.11(6.43)**
*Significant difference between A and B (P < 0.05)
**Significant difference between A and C (P < 0.05)
Pulse Rate (/min)
Baseline 113.94(21.94) 113.06(27.04) 106.24(20.16)
Post- 0min-0.18(10.00)* 0.65(8.70)** 11.59(10.23)***
Post- 30min -0.41(11.58)* 0.53(9.78)** 22.35(14.91)***
Post- 60min -0.59(12.92)* 0.88(9.16)** 18.71(15.46)***
Post-120min -2.41(10.98)* -1.88(12.31)**20.94(18.05)***
*Significant difference between A and C at any point (P < 0.05)
**Significant difference between B and C at any point (P < 0.05)
Conclusion: Method B can achieve at least the same bronchodilation effect as Methods A and C but requires the least cost. Method C can significantly increase the patient's pulse rate, probably due to drug effect or irritation.