Inhaled Bronchodilators: indications and administration techniques among patients on ventilatory support

Abstract

Many bronchodilator drugs are available for inhaled administration using nebulizers or metered dose inhalers; the molecules most evaluated in the context of ventilatory support being salbutamol and ipratropium which have a short duration of action. Bronchodilators are frequently used in intensive care units mainly for the treatment of acute exacerbations of chronic obstructive pulmonary diseases, despite the absence of a high level of evidence regarding their benefit on patient-centered outcomes. Their therapeutic index is broad with a physiological efficacy observed for low doses and a good tolerance, even at high doses. Nevertheless, some cardiovascular adverse effects may occur even after inhaled pulmonary administration. Administration modalities are different depending on the type of ventilatory support but are generally simple whether it is during non-invasive ventilation, nasal high flow therapy or invasive ventilation, because of the broad therapeutic index not requiring any optimization technique. Beyond clinical monitoring during administration, placement of a filter on the expiratory limb protecting the ventilator is an important safety measure.