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.