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Two administration methods for inhaled salbutamol in intubated patients
  1. S S Garner1,
  2. D B Wiest1,
  3. J W Bradley3,
  4. D M Habib2
  1. 1Department of Pharmacy Practice, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2Department of Pediatrics, Medical University of South Carolina
  3. 3Department of Pediatric Respiratory Care, Medical University of South Carolina
  1. Correspondence to:
    Dr S S Garner, Department of Pharmacy Practice, Medical University of South Carolina, QF-411, 280 Calhoun Street, PO Box 250145, Charleston, SC 29425, USA;


Aims: To compare serum concentrations and effects on respiratory mechanics and haemodynamics of salbutamol administered by small volume nebuliser (SVN) and metered dose inhaler (MDI) plus spacer.

Methods: Blinded, randomised, crossover study in 12 intubated infants and children (mean age 17.8 months) receiving inhaled salbutamol therapy. Subjects received salbutamol as 0.15 mg/kg by SVN and four puffs (400 μg) by MDI plus spacer at a four hour interval in random order. Passive respiratory mechanics were measured by a single breath/single occlusion technique, and serum salbutamol concentrations by liquid chromatography–mass spectrometry at 30 minutes, 1, 2, and 4 hours after each dose. Haemodynamics (heart rate and blood pressure) were recorded at each measurement time.

Results: There was no difference in percentage change in respiratory mechanics or haemodynamics between the two methods of administration. Mean area under the curve (AUC0–4) was 5.86 for MDI plus spacer versus 4.93 ng/ml × h for SVN.

Conclusions: Serum concentrations and effects on respiratory mechanics and haemodynamics of salbutamol were comparable with the two administration methods under the conditions studied. Future studies are needed to determine the most effective and safe combination of dose and administration method of inhaled salbutamol in mechanically ventilated infants and children.

  • aerosol
  • mechanical ventilator
  • inhalation
  • bronchodilator
  • AUC0–4, area under the serum concentration–time curve from 0 to 4 hours
  • Crs, respiratory system compliance
  • DBP, diastolic blood pressure
  • ETT, endotracheal tube
  • HR, heart rate
  • MDI, metered dose inhaler
  • Rrs, respiratory system resistance
  • SBP, systolic blood pressure
  • SVN, small volume nebuliser

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  • Supported by Glaxo Wellcome Inc.