Albuterol
Ipratropium
Levalbuterol (Xopenex)
Budesonide (only Pulmicort Respule)
MDI
• Only aerosol system MDI can be used; drugs in powder form such as Advair diskus cannot be used. The therapist must synchronize the medication delivery with the inhalation phase of the ventilator cycle for delivery. The use of MDI in ventilated patients is infrequent. Medications include:
ProAir (albuterol)
Combivent (albuterol/ipratropium)
Standard Dosing
Albuterol
• Dose: NEB: 2.5mg q3-6h. MDI: 2 puffs inhaled q4-6h
Note: Patients who have severe bronchospasm and cannot be ventilated can be given albuterol more often or even continuously. However, they should be closely monitored. This should be prescribed by a specialist.
Ipratropium
• Dose: NEB 500 mcg q6-8h. MDI 2puffs inhaled q6h
Ipratropium/albuterol
• Dose: NEB: (DuoNeb) 500mcg/ 2.5mg q6h. MDI (Combivent) 1–2 puffs inhaled q6h 55
Budesonide
• Dose: NEB (Pulmicort Respules) 0.25mg or 0.5mg q12h
Note: Not indicated to relieve acute bronchospasm. Dosing above 0.5mg per day may have some systemic steroid effects.
Levalbuterol.
• Dose: NEB 1.25 mg q6-8h. MDI 2 puffs inhaled q4-6h
Note: it is an isomer of albuterol. It can be a useful alternative for patients with clinically significant side effects of albuterol such as tremor and tachycardia.
Tobramycin
• Dose: NEB: 300mg q12h for 30 days on and then 30 days off.
Note: Usually reserved for Pseudomonas infections in patients with chronic airway diseases such as cystic fibrosis or bronchiectasis.
N-acetylcysteine
• Dose: NEB: 3–5 mL 20% sol or 6–10 mL 10% sol q6–8h Note: may be used to mobilize secretions. Give bronchodilator 10–15 min before the dose to avoid bronchospasm.
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