The Science Journal of the American Association for Respiratory Care

1999 OPEN FORUM Abstracts

A SURVEY OF ALBUTEROL ADMINISTRATION PRACTICES IN THE NEWBORN ICU.

Julie Ballard RRT, BS, John W. Salyer RRT, BS, MBA, FAARC, Janet M. Quigley, Ralph A. Lugo PharmD, Primary Children's Medical Center and the University of Utah, Salt Lake City, UT.

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 (%)
100 19
75-99 22
50-74 9
25-49 4
1-24 3
0 43


Table 2: Nebulizer Placement
Nebulizer Placement Hospitals (%)
Inspir limb near wye 45
Midway down inspir limb 29
Handbagged 12
At humidifier 10
Between ETT & wye 4

OF-99-210

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