Respiratory response to salbutamol (albuterol) in ventilator-dependent infants with chronic lung disease: pressurized aerosol delivery versus intravenous injection

OBJECTIVE: To compare the effects of intravenously injected with inhaled salbutamol in ventilator dependent infants with chronic lung disease (CLD). DESIGN: Prospective randomized study in which each patient served as his/her own control. SETTING: Multidisciplinary neonatal and pediatric ICU. PATIENTS: 8 ventilator dependent premature infants with CLD. INTERVENTIONS: Salbutamol, 10 μg/kg was given intravenously, and 10–19 h later, twice 100 μg as pressurized aerosol, or vice versa, sequence randomized. The pressurized aerosol was delivered by a metered dose inhaler into a newly developed aerosol holding chamber, integrated into the inspiratory limb of the patient circuit. Respiratory system mechanics were assessed by the single breath occlusion method before and 10 and 60 min after drug administration. MEASUREMENTS AND RESULTS: Compliance improved significantly after intravenous injection (0.48±0.18 to 0.67±0.16, p<0.01 and 0.59±0.23 ml/cmH(2)O/kg, NS, (mean±1 SD) and after inhalation (0.46±0.19 to 0.64±0.32,p<0.01 and 0.56±0.31 ml/cmH(2)O/kg, NS). Resistance decreased after i.v. use (0.38±0.17 to 0.25±0.11,p<0.001 and 0.25±0.10 cmH(2)O/ml/s, NS) and after inhalation (0.35±0.12 to 0.27±0.09,p<0.01 and 0.28±0.12 cmH(2)O/ml/s, NS). Heart rate increased significantly after both routes of application, whereas mean arterial pressure, respirator settings, FIO(2), transcutaneous SO(2) and capillary PCO(2) did not change. CONCLUSIONS: Inhaled and intravenous salbutamol improves pulmonary mechanics to the same extent with comparable side effects, and may therefore be used to facilitate weaning from respirators.