Metered dose inhalers for bronchodilator delivery in intubated, mechanically ventilated patients

Chest. 1991 Jan;99(1):66-71. doi: 10.1378/chest.99.1.66.


We determined the relative efficacy of two bronchodilator aerosol delivery methods in 18 intubated mechanically ventilated patients with airways obstruction. Two treatment arms, consisting of albuterol 270 micrograms (three puffs) from a metered dose inhaler and albuterol 2.5 mg from a saline solution nebulized with an updraft inhaler, were compared in a single blind, randomized crossover design. Pulmonary function was evaluated using an interrupter technique. Changes in passive expiratory flow at respiratory system recoil pressures between 6 and 10 cm H2O provided the therapeutic endpoints. Paired measurements were made before and 30 minutes after drug delivery. The MDI and NEB resulted in similar improvements in iso-recoil flow (mean increase for both groups = 0.1 L/s). Treatment sequence, severity of obstruction, and bronchodilator responsiveness had no effect on relative efficacy. Albuterol caused a small but significant increase in heart rate that was similar following both delivery methods. We conclude that bronchodilator aerosol delivery with metered dose inhalers provides a viable alternative to nebulizer therapy in intubated mechanically ventilated patients and may result in a cost savings to hospitals and patients.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aerosols
  • Aged
  • Albuterol / administration & dosage*
  • Albuterol / therapeutic use
  • Asthma / therapy
  • Costs and Cost Analysis
  • Female
  • Humans
  • Intubation, Intratracheal*
  • Lung Diseases, Obstructive / therapy
  • Male
  • Nebulizers and Vaporizers*
  • Respiration, Artificial*
  • Single-Blind Method


  • Aerosols
  • Albuterol