The Science Journal of the American Association for Respiratory Care
Introduction: The practice of administering Albuterol (ALB) by metered dose inhaler (MDI) is increasing in ventilated neonates. This study was designed to measure some aspects of this practice.
Methods: A survey instrument was developed that measured 27 aspects of ALB administration. The survey was administered by phone to hospitals with a neonatal fellowship program (J Pediatr 1999;134(1):41A-45A). Participation was requested from respiratory therapists or managers having direct knowledge of neonatal clinical practices. Results are reported as percentages and where applicable ± 1 SD. Results: Eighty-one hospitals were eligible for participation and there were 68 responses (84% response rate). Responders averaged 35 ± 13 NICU beds and 11 ± 5 ventilators/day. Fifty-seven percent of respondents reported administering ALB by MDI. Table 1 describes the breakdown of ALB MDI usage. The following doses of ALB were reported: average dose 1 puff = 31%, 2 puffs = 64%, 4 puffs = 5%; maximum dose 2 puffs = 31%, 3 puffs = 14%, 4 puffs = 34%, 6 puffs = 11%, 8 puffs = 6%. One hospital reported using up to 40 puffs per treatment. ALB MDI/spacer is placed in-line in 32% of hospitals, hand-bagged in 55% or administered both ways in 13%. In-line spacer placement was reported as follows: between ETT and ventilator circuit = 56%, and in the inspiratory limb = 44%. Waiting time between MDI actuations: 20 sec = 6%, 30 sec = 26%, 45 sec = 14%, 60 sec = 46%, 90 sec = 3%, 120 sec = 3%, 180 sec = 3%. When asked whether spacer dead space is of concern, 83% said no. If ALB is administered by nebulizer, placement of the nebulizer is described in Table 2. One hospital reported administering ALB directly down the ETT. Discussion: The majority of respondents administer ALB by MDI and average 1-2 actuations per treatment. The most common waiting period is 30-60 sec between actuations and there was little concern about the dead space introduced by spacers. It is noteworthy that 42% of institutions continue to administer ALB by nebulizer despite the inefficiencies of this method. Furthermore, there is a lack of consensus regarding nebulizer placement.
|Table 1: MDI Usage|
|ALB Administered by MDI (%)||Hospitals (%)|
|Table 2: Nebulizer Placement|
|Nebulizer Placement||Hospitals (%)|
|Inspir limb near wye||45|
|Midway down inspir limb||29|
|Between ETT & wye||4|