A Prospective Controlled Trial of Albuterol Aerosol Delivered Via Metered Dose Inhaler-Spacer Device (MDI) Versus Jet Nebulizer in Ventilated Preterm Neonates

ABSTRACT

The objective of this study was to identify the most efficient and cost-effective nebulizer device for delivery of albuterol aerosol as a bronchodilator in ventilated preterm infants. Bronchodilators are frequently used as part of the therapeutic regimen of ventilated preterm infants. This can be delivered by different types of nebulizers like the Jet or metered dose inhaler (MDI) spacer device. Fifty-three premature infants being ventilated for RDS (24 to 34 weeks of gestation) were studied just prior to extubation. Twenty-four of them received standard doses of albuterol aerosol via Jet nebulizer and 29 via MDI-spacer. Heart rate, respiratory rate, oxygen saturation, lung compliance, and airway resistance were monitored prior and 15 minutes after albuterol delivery. There were significant changes in the parameters studied between pre- and postnebulizer treatment. In both groups, there was a significant improvement in lung function as evidenced by 13-24% decreased airway resistance (RAW_E) and 3-7% increased lung compliance (CDYN). There was also a beneficial clinical response as demonstrated by increased oxygen saturations. These findings suggest that both MDI-spacer and Jet nebulizer are equally effective in delivering the albuterol aerosol to the lower respiratory tract. Since a small dose of albuterol delivered via the MDI-spacer improved lung function as effectively as a higher dose via the Jet nebulizer, the MDI-spacer would be the preferred mode of aerosol administration, especially because it takes only 2 minutes to deliver it. Furthermore, it was also cost-effective as one MDI-spacer treatment costs 2 cents, while a Jet treatment costs 10 cents in our neonatal intensive care unit (NICU).

KEYWORD

Jet nebulizer - MDI-spacer - NICU

REFERENCES

• 1 Rotschild A, Solimano A, Puterman M, Smyth J, Sharma A, Albershelm S. Increased compliance in response to salbutamol in premature infants with developing bronchopulmonary dysplasia.  J Pediatr . 1989;  115 984-991
• 2 Denjean A, Guimaraes H, Migdal M, Miramand J L, Dehan M, Gaultier C. Dose related bronchodilator response to aerosolized salbutamol (albuterol) in ventilator dependent premature infants.  J Pediatr . 1992;  120 974-979
• 3 Lee H, Arnon S, Silverman M. Bronchodilator aerosol administered by metered dose inhaler and spacer in subacute neonatal respiratory distress syndrome.  Arch Dis Child . 1994;  70 F218-F222
• 4 Kao L C, Warburton D, Platzker A CG, Keens T G. Effect of isoproterenol inhalation on airway resistance in chronic bronchopulmonary dysplasia.  Pediatrics . 1984;  73 509-514
• 5 Kraemer R, Birrer P, Modelski K, Aebischer C C, Schoni M H. A new baby-spacer device for aerosolized bronchodilator administration in infants with bronchopulmonary dysplasia.  Eur J Pediatr . 1992;  151 57-60
• 6 Wilkie R A, Bryan M H. Effect of bronchodilator on airway resistance in ventilator-dependent neonates with chronic lung disease.  J Pediatr . 1987;  111 278-282
• 7 Cabal L A, Larrazabal C, Ramanathan R. Effects of metaproterenol on pulmonary mechanics, oxygenation, and ventilation in infants with chronic lung disease.  J Pediatr . 1987;  110 116-119
• 8 Pfenninger J, Aebl C. Respiratory response to salbutamol (albuterol) in ventilator-dependent infants with chronic lung disease: pressurized aerosol delivery versus intravenous injection.  Intensive Care Med . 1993;  19 251-255
• 9 Merrit T A, Northway W H, Boynton B. Bronchopulmonary dysplasia. In: Merrit TA, Northway WH, Boynton B, eds. Contemporary Issues in Fetal and Neonatal Medicine Vol. 4. Boston: Blackwell Scientific Publications 1988: 428-430
• 10 Fok T F, Dolovich M, Gary S. Efficiency of aerosol medication delivery from a metered dose inhaler versus jet nebulizer in infants with bronchopulmonary dysplasia.  Pediatr Pulmonol . 1996;  21 301-309
• 11 Gappa M, Grtner M, Poets C F, Von der Hardt H. Effects of salbutamol delivery from a metered dose inhaler versus jet nebulizer on dynamic lung mechanics in very preterm infants with chronic lung disease.  Pediatr Pulmonol . 1997;  23 442-448
• 12 Kerem E, Levison H, Schuh S. Efficacy of albuterol administrated by nebulizer versus spacer device in children with acute asthma.  J Pediatr . 1993;  123 313-317
• 13 Parkin P, Saunders N, Diamond S, Winders P, Macarthur C. Randomised trial spacer vs nebulizer for acute asthma.  Arch Dis Child . 1995;  72 239-240
• 14 Fok T F, Lam K, Ng P C. Delivery of salbutamol to nonventilated preterm infants by metered-dose inhaler, jet nebulizer, and ultrasonic nebulizer.  Eur Respir J . 1998;  12 159-164
• 15 Fok T F, Lam K, Ng P C. Randomised crossover trial of salbutamol aerosol delivered by metered dose inhaler, jet nebulizer, and ultrasonic nebulizer in chronic lung disease.  Arch Dis Child Fetal Neonatal Ed . 1998;  79 F100-F104
• 16 Sivakumar D, Bosque E, Goldman S L. Bronchodilator delivered by metered dose inhaler and spacer improves respiratory system compliance more than nebulizer-delivered bronchodilator in ventilated premature infants.  Pediatr Pulmonol . 1999;  27 208-212
• 17 Whyte V, Malinowski T, Ellis G. FiO₂ changes during MDI actuating in the infant test lung.  Pediatr Potpourri . 1993;  14 1