Abstract
AIMS—To compare the efficacy of salbutamol delivered by metered dose inhaler (MDI), jet nebuliser, and ultrasonic nebuliser in ventilated infants with chronic lung disease. METHODS—Twenty preterm ventilated infants with chronic lung disease were enrolled in two studies. In study 1 (n=10), each infant was given 200 µg of salbutamol at 4 hour intervals and in random sequence from a metered dose inhaler-spacer device, a jet nebuliser, and an ultrasonic nebuliser with a small medication cup. The infants were monitored for heart rate, transcutaneous pO2, pCO2, and oxygen saturation, respiratory system resistance and compliance before and after each treatment. Infants in study 2 (n=10) were similarly studied except for the use of a different jet nebuliser. RESULTS—The mean (SEM) maximum percentage decreases in respiratory system resistance, observed at 30 minutes after aerosol delivery were study 1: MDI: 44.3 (4.3)% ; jet: 32.3 (3.4)% ; ultrasonic: 56.1 (3.2)% ; study 2: MDI: 28.6 (1.0)% ; jet: 16.9 (1.4)% ; ultrasonic: 42.1 (1.6)%. During the first hour after treatment, a significantly faster heart rate and higher transcutaneous pO2 were associated with the use of the ultrasonic nebuliser or MDI than with the jet nebulisers in both studies. The use of the ultrasonic nebuliser but not the other devices also resulted in a lower transcutaneous pCO2 and improved respiratory system compliance in study 2. CONCLUSIONS—These findings suggest that among the devices tested, the delivery of salbutamol aerosol to the lower respiratory tract was greatest using the ultrasonic nebuliser, and least with the jet nebulisers.
Full Text
The Full Text of this article is available as a PDF (110.0 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Arnon S., Grigg J., Nikander K., Silverman M. Delivery of micronized budesonide suspension by metered dose inhaler and jet nebulizer into a neonatal ventilator circuit. Pediatr Pulmonol. 1992 Jul;13(3):172–175. doi: 10.1002/ppul.1950130309. [DOI] [PubMed] [Google Scholar]
- Brundage K. L., Mohsini K. G., Froese A. B., Fisher J. T. Bronchodilator response to ipratropium bromide in infants with bronchopulmonary dysplasia. Am Rev Respir Dis. 1990 Nov;142(5):1137–1142. doi: 10.1164/ajrccm/142.5.1137. [DOI] [PubMed] [Google Scholar]
- Cameron D., Arnot R., Clay M., Silverman M. Aerosol delivery in neonatal ventilator circuits: a rabbit lung model. Pediatr Pulmonol. 1991;10(3):208–213. doi: 10.1002/ppul.1950100314. [DOI] [PubMed] [Google Scholar]
- Cameron D., Clay M., Silverman M. Evaluation of nebulizers for use in neonatal ventilator circuits. Crit Care Med. 1990 Aug;18(8):866–870. doi: 10.1097/00003246-199008000-00015. [DOI] [PubMed] [Google Scholar]
- Denjean A., Guimaraes H., Migdal M., Miramand J. L., Dehan M., Gaultier C. Dose-related bronchodilator response to aerosolized salbutamol (albuterol) in ventilator-dependent premature infants. J Pediatr. 1992 Jun;120(6):974–979. doi: 10.1016/s0022-3476(05)81973-0. [DOI] [PubMed] [Google Scholar]
- Everard M. L., Stammers J., Hardy J. G., Milner A. D. New aerosol delivery system for neonatal ventilator circuits. Arch Dis Child. 1992 Jul;67(7 Spec No):826–830. doi: 10.1136/adc.67.7_spec_no.826. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Flavin M., MacDonald M., Dolovich M., Coates G., O'Brodovich H. Aerosol delivery to the rabbit lung with an infant ventilator. Pediatr Pulmonol. 1986 Jan-Feb;2(1):35–39. doi: 10.1002/ppul.1950020110. [DOI] [PubMed] [Google Scholar]
- Fok T. F., Al-Essa M., Monkman S., Dolovich M., Girard L., Coates G., Kirpalani H. Pulmonary deposition of salbutamol aerosol delivered by metered dose inhaler, jet nebulizer, and ultrasonic nebulizer in mechanically ventilated rabbits. Pediatr Res. 1997 Nov;42(5):721–727. doi: 10.1203/00006450-199711000-00027. [DOI] [PubMed] [Google Scholar]
- Fok T. F., Monkman S., Dolovich M., Gray S., Coates G., Paes B., Rashid F., Newhouse M., Kirpalani H. Efficiency of aerosol medication delivery from a metered dose inhaler versus jet nebulizer in infants with bronchopulmonary dysplasia. Pediatr Pulmonol. 1996 May;21(5):301–309. doi: 10.1002/(SICI)1099-0496(199605)21:5<301::AID-PPUL5>3.0.CO;2-P. [DOI] [PubMed] [Google Scholar]
- Gappa M., Gärtner M., Poets C. F., von der Hardt H. Effects of salbutamol delivery from a metered dose inhaler versus jet nebulizer on dynamic lung mechanics in very preterm infants with chronic lung disease. Pediatr Pulmonol. 1997 Jun;23(6):442–448. doi: 10.1002/(sici)1099-0496(199706)23:6<442::aid-ppul8>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]
- Grigg J., Arnon S., Jones T., Clarke A., Silverman M. Delivery of therapeutic aerosols to intubated babies. Arch Dis Child. 1992 Jan;67(1 Spec No):25–30. doi: 10.1136/adc.67.1_spec_no.25. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lee H., Arnon S., Silverman M. Bronchodilator aerosol administered by metered dose inhaler and spacer in subacute neonatal respiratory distress syndrome. Arch Dis Child Fetal Neonatal Ed. 1994 May;70(3):F218–F222. doi: 10.1136/fn.70.3.f218. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lesouef P. N., England S. J., Bryan A. C. Passive respiratory mechanics in newborns and children. Am Rev Respir Dis. 1984 Apr;129(4):552–556. [PubMed] [Google Scholar]
- Motoyama E. K., Fort M. D., Klesh K. W., Mutich R. L., Guthrie R. D. Early onset of airway reactivity in premature infants with bronchopulmonary dysplasia. Am Rev Respir Dis. 1987 Jul;136(1):50–57. doi: 10.1164/ajrccm/136.1.50. [DOI] [PubMed] [Google Scholar]
- Northway W. H., Jr, Rosan R. C., Porter D. Y. Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med. 1967 Feb 16;276(7):357–368. doi: 10.1056/NEJM196702162760701. [DOI] [PubMed] [Google Scholar]
- O'Callaghan C., Hardy J., Stammers J., Stephenson T. J., Hull D. Evaluation of techniques for delivery of steroids to lungs of neonates using a rabbit model. Arch Dis Child. 1992 Jan;67(1 Spec No):20–24. doi: 10.1136/adc.67.1_spec_no.20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pfenninger J., Aebi C. Respiratory response to salbutamol (albuterol) in ventilator-dependent infants with chronic lung disease: pressurized aerosol delivery versus intravenous injection. Intensive Care Med. 1993;19(5):251–255. doi: 10.1007/BF01690544. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rotschild A., Solimano A., Puterman M., Smyth J., Sharma A., Albersheim S. Increased compliance in response to salbutamol in premature infants with developing bronchopulmonary dysplasia. J Pediatr. 1989 Dec;115(6):984–991. doi: 10.1016/s0022-3476(89)80755-3. [DOI] [PubMed] [Google Scholar]
- Silverman M. Aerosol therapy in the newborn. Arch Dis Child. 1990 Aug;65(8):906–908. doi: 10.1136/adc.65.8.906. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Thomas S. H., O'Doherty M. J., Page C. J., Treacher D. F., Nunan T. O. Delivery of ultrasonic nebulized aerosols to a lung model during mechanical ventilation. Am Rev Respir Dis. 1993 Oct;148(4 Pt 1):872–877. doi: 10.1164/ajrccm/148.4_Pt_1.872. [DOI] [PubMed] [Google Scholar]
- Watterberg K. L., Clark A. R., Kelly H. W., Murphy S. Delivery of aerosolized medication to intubated babies. Pediatr Pulmonol. 1991;10(2):136–141. doi: 10.1002/ppul.1950100217. [DOI] [PubMed] [Google Scholar]
- Wilkie R. A., Bryan M. H. Effect of bronchodilators on airway resistance in ventilator-dependent neonates with chronic lung disease. J Pediatr. 1987 Aug;111(2):278–282. doi: 10.1016/s0022-3476(87)80087-2. [DOI] [PubMed] [Google Scholar]
- Yuksel B., Greenough A. Effect of nebulized salbutamol in preterm infants during the first year of life. Eur Respir J. 1991 Oct;4(9):1088–1092. [PubMed] [Google Scholar]