The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

Impact of Aeroneb Therapy in the Pediatric Mechanically Ventilated Patient: A Retrospective Case Series Review.

Lisa Tyler, BS, RRT-NPS, CPFT, Roberta Hales, BS, RRT-NPS, RN, Angela Hedgman, AS, RRT-NPS, Susan Ferry, RRT, Cheryl DeFalco, RRT-NPS, Linda Napoli, MBA, RRT-NPS, RPFT, R. I. Godinez, MD, PhD; The Children’s Hospital of Philadelphia, Philadelphia, PA

Introduction: Over 5 million children each year experience some form of asthma exacerbation. Many of these exacerbations are severe enough to warrant an ICU admission. Of these, some progress to require endotracheal intubation and mechanical ventilation. Universal administration of beta2-agonist medication is via metered dose inhaler or standard small volume nebulizer. The Aeroneb® offers an alternative method for beta2-agonist delivery. Limited data is published in the pediatric population on its use.

Methods
: In a 41 bed pediatric intensive care unit, use of the Aerogen Aeroneb® was studied in four severe intubated asthmatic patients. The Aeroneb® was placed between the patient wye and inspiratory limb of the ventilator circuit. All patients were dosed to receive an equivalent of 1ml/hr of albuterol sulfate with no dilutant. This is a retrospective chart review.

Results
: Data were analyzed prior to Aeroneb® implementation and at intervals of 2, 4, and 8 hours post administration. In all cases changes in ventilator setting and sedation were considered insignificant. There was no significant beta 1 effect as evidenced by stable vital signs. Table 1 illustrates the measured exhaled tidal volumes or peak inspiratory pressures followed by the % change from baseline data in all four patients.

Table 1:

Tidal Volume/Peak Inspiratory Pressure Hourly Response Chart

PCV Weight Baseline 2 Hour 4 Hour 8 Hour
Patient 1 59 kg 356 ml 471 ml (32) 486 ml (36) 687 ml (93)
Patient 2 20 kg 305 ml 319 ml (5) 380 ml (25) 475 ml (56)
Patient 3 50 kg 250 ml 318 ml (27) 450 ml (80) 465 ml (86)
VCV          
Patient 4 32 kg 36 cmH2O 36 (0) 26 (28) 30 (17)

Conclusion: All patients in this data analysis group demonstrate a positive bronchodilator response as assessed by ventilator parameters. In the pressure control group, increase in tidal volume was measured at 2, 4, and 8 hours in all 3 patients. Tidal volume increase was considered a relative indicator of favorable therapy. In the volume control case, peak inspiratory pressure was substituted for tidal volume as the relative measure. Although limited, data supports the use of the Aeroneb® in this population. Future studies are needed to validate if the Aeroneb® is superior to traditional methods of medication administration via mechanical ventilation.

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