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The effects of nebulized salbutamol, external positive end-expiratory pressure, and their combination on respiratory mechanics, hemodynamics, and gas exchange in mechanically ventilated chronic obstructive pulmonary disease patients.

Abstract
We hypothesized that combined salbutamol and external positive end-expiratory pressure (PEEPe) may present additive benefits in chronic obstructive pulmonary disease (COPD) exacerbation. In 10 anesthetized, mechanically ventilated, and bronchodilator-responsive COPD patients exhibiting moderate intrinsic PEEP (PEEPi), we assessed respiratory system (rs) mechanics, hemodynamics, and gas exchange at (a) baseline (zero PEEPe [ZEEPe]), (b) 30 min after 5 mg of nebulized salbutamol administration (ZEEPe-S), (c) 30 min after setting PEEPe at baseline PEEPi level (PEEPe), and (d) 30 min after 5 mg of nebulized salbutamol administration with PEEPe maintained unchanged (PEEPe-S). Return of determined variable values to baseline values was confirmed before PEEPe application. Relative to ZEEPe, (a) at ZEEP-S, PEEPi (4.8 +/- 0.7 versus 7.0 +/- 1.1 cm H(2)O), functional residual capacity change (115.6 +/- 23.1 versus 202.1 +/- 46.0 mL), minimal rs (airway) resistance (9.3 +/- 1.4 versus 11.8 +/- 2.2 cm H(2)O.L(-1).s(-1)), and additional rs resistance (5.2 +/- 1.4 versus 7.2 +/- 1.3 cm H(2)O.L(-1).s(-1)) were reduced (P < 0.01), and hemodynamics were improved; (b) at PEEPe, PEEPi (3.7 +/- 1.3 cm H(2)O) was reduced (P < 0.01), and gas exchange was improved; and (c) at PEEPe-S, PEEPi (2.0 +/- 1.2 cm H(2)O) was minimized, and rs mechanics (static rs elastance included), hemodynamics, and gas exchange were improved. Conclusively, in carefully preselected COPD patients, bronchodilation/PEEPe exhibits additive benefits.
AuthorsMaria Tzoufi, Spyros D Mentzelopoulos, Charis Roussos, Apostolos Armaganidis
JournalAnesthesia and analgesia (Anesth Analg) Vol. 101 Issue 3 Pg. 843-850 (Sep 2005) ISSN: 0003-2999 [Print] United States
PMID16116002 (Publication Type: Journal Article)
Chemical References
  • Aerosols
  • Bronchodilator Agents
  • Albuterol
Topics
  • Aerosols
  • Aged
  • Albuterol (administration & dosage, pharmacology)
  • Body Weight (physiology)
  • Bronchodilator Agents (administration & dosage, pharmacology)
  • Electrocardiography
  • Female
  • Functional Residual Capacity
  • Hemodynamics (drug effects, physiology)
  • Humans
  • Male
  • Middle Aged
  • Positive-Pressure Respiration
  • Pulmonary Disease, Chronic Obstructive (drug therapy, physiopathology, therapy)
  • Pulmonary Gas Exchange (drug effects, physiology)
  • Respiratory Mechanics (drug effects, physiology)

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