The Science Journal of the American Association for Respiratory Care

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.





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