Albuterol in the intubated patient.

[DirtJerZ]

I am a newer medic and have been working in a city for one year. On a few occasions i have seen a few medics give albuterol down the tube in cardiac arrest patients with history of asthma. Is this beneficial for the patient? Are there any adjuncts to use neb treatments through a BVM? Do you have to hear wheezes when you do this? Or, is this all just a waste of time?

[Doczilla]

I don't think it's beneficial in cardiac arrest if you are giving epi IV or down the tube.

We give puffs of albuterol and combivent inline with the ventilator circuit in intubated ICU patients for COPD, pneumonia, pulmonary inflammation, asthma, etc. You can hear wheezes in intubated patients. There is the "silent chest" syndrome wherein you will not hear any wheezes, if they are so tight that they aren't moving air at all.

'zilla

[VentMedic]

Just intubating a patient does not make the problems associated with COPD and asthma go away.

Pouring albuterol down the ETT rarely works due to particle size, med adhering to ETT and cough response which prevents the medicine from getting to the smaller airways that need bronchodilating.

We (in hospital and interfacility specialty or CCT) utilize MDIs and nebs both inline and with the BVM while waiting for the appropriate ventilator to be set up. 15 and 22 mm adapters can assist with connecting the BVM to the neb and tube. Many nebulizer T-pieces are designed with these connections for easy use in the field.

Many expect immediate results from one bronchodilator neb. Often it is necessary to run high dose nebulized Albuterol either concentrated with the 0.5% solution with a special nebulizer on either intubated or non-intubated patient. This can also be diluted with Normal Saline to run continuous at doses of 5 - 30 mg per hour with or without a ventilator/ETT. Again a specially designed nebulizer is utilized. Putting several unit doses of Albuterol into a standard "acorn" neb may reduce its ability to nebulize the appropriately sized aerosol particles for maximum depostion. For your situations, you will still need to follow your protocols for dosage.

There are times when the patient is so tight that heli-ox (helium and oxygen mixture) may be used to facilitate ventilation either by mask or ventilator. This may be required for several days until the inflammatory response subsides.

The articles listed below are probably more information than you will need to know in most cases but aerosol delivery is a well studied science and an art. For the field you just need to adapt your nebulizer to the tube and the BVM. Be aware that the extra flow from the nebulizer with increase your delivered tidal volumes and can also hinder exhalation somewhat when "bagging in" a treatment.

http://www.rcjournal.com/contents/09.05/09.05.1151.pdf

http://www.aarc.org/marketplace/reference_.../01.99.0053.pdf

http://www.chestjournal.org/cgi/content/full/115/1/184

[DirtJerZ]

Thank you very much. Now i know exactly what i needed to know. The heliox article was the only link that worked. Thanks again for the info.

[VentMedic]

The heliox article was the only link that worked. Thanks again for the info.

The other articles are pdf files.

[explenture]

We don't do meds down ETT.

[DirtJerZ]

We don't do meds down ETT.

Umm, really. Well i gave atropine and epi down the tube the other day. Might wanna check into that statement a little more.

[explenture]

Umm, really. Well i gave atropine and epi down the tube the other day. Might wanna check into that statement a little more.

Our protocols don't allow it.

[DirtJerZ]

Our protocols don't allow it.

thats really interesting, in NJ we give 2-2.5 x dose down the tube to a max of 50 cc's we can give narcan, lidocaine, atropine and epi 1:1,000. I have never given lido or narcan down the tube but im sure we can use it.

[Kaisu]

ETT as an administration route for medications has fallen out of favor here. I/O is much better if you cant get a line.