2004 OPEN FORUM Abstracts
ALBUTEROL DELIVERY THROUGH EXTRA-LONG TRACHEOSTOMY TUBES.
Helen
V. Whitmore, RRT; Dean R. Hess, PhD, RRT, FAARC. Massachusetts
General Hospital and Harvard Medical School, Boston MA.
Background:
Inhaled albuterol is commonly administered to mechanically ventilated
patients who have a tracheostomy tube in place. Due to peculiarities
in their anatomy, some patients require a tracheostomy tube with
extra length.
Hypothesis: Albuterol delivery is reduced
through a tracheostomy tube of extra length.
Methods: A
Puritan-Bennett 840 ventilator was set to deliver a tidal volume of
0.5 L, respiratory rate 12/min, and a flow of 30 L/min. The delivered
gas was fully humidified at 35 C. The circuit was attached to a
tracheostomy tube, the distal end of which was attached to a
Puritan-Bennett D/Flex filter. The filter was attached to a test lung
with a compliance of 50 mL/cm H2O. A Monaghan AeroVent
spacer was placed into the ventilator circuit and a pressurized
metered-dose inhaler was actuated into the spacer synchronized with
the initiation of inhalation (4 actuations separated by ≥
30 s). Albuterol was washed from the filter with 0.1 N NaOH and
assessed for albuterol by spectrophotometry at 243 nm. Tracheostomy
tubes of three designs with an inner diameter of 8 mm were evaluated:
Shiley Single Cannula Tracheostomy (SCT), Shiley XLT Proximal
Extension, Shiley XLT Distal Extension. Each set of conditions was
repeated in quadruplicate.
Results: Albuterol delivery was
significantly less for the tracheostomy tubes with extra length (P <
0.02); see figure. There was no difference between the proximal
extension and distal extension tubes (P = 0.9).
Conclusions:
Albuterol delivery is reduced if a tracheostomy with extra length is
used. If such a tube is used, it may be necessary to increase the
dose to compensate for the additional drug loss in the tracheostomy
tube. Further work is needed to determine whether these results can
be generalized to extra length tubes from other manufacturers. These
data should be subjected to clinical study.
