1.Review order, identify patient, and asses the need for bronchodilator therapy
2.Minimize leaks in the mask and/or circuit
3.Shake pMDI and warm it to hand temperature
4.Be sure that the dose counter is attached to the pMDI
5.Place the pMDI with chamber spacer
(a)Near the “Y” adapter in inspiratory limb for dual-limb circuit
(b)Between the leak port and mask for single-limb circuit
6.Coordinate pMDI action with beginning of inspiration
7.Wait at least 15 s between actuations, and administer the total dose
8.Remove pMDI with spacer from circuit
9.Monitor for adverse effects
Table 21.2
Optimal technique for drug delivery by a nebulizer in patients undergoing NIV
1.Review order, identify patient, and asses the need for a bronchodilator therapy |
2.Minimize leaks in the mask and/or circuit |
3.Place mesh/jet nebulizer |
(a)Between the leak port and mask in a single-limb circuit |
(b)Near the “Y” adapter in the inspiratory limb of a dual-limb circuit |
4.Pour the recommended drug volume into the nebulizer |
5.Set the gas flow to nebulizer at 2–10 l/min, based on the manufacturer label |
6.Run until the nebulizer begins to sputter |
7.Remove the nebulizer from the circuit, rinse with sterile water, run dry |
8.Monitor for adverse effects |
21.4 Conclusion
Despite the common use of aerosol drugs during NIV, it is still unclear which technique should be used for aerosol delivery. In recent decades, a number of bench model studies during NIV and in vitro studies during IMV have defined some settings allowing successful aerosol therapy. Unfortunately, only a few investigators have studied aerosol delivery in patients undergoing NIV. Aerosolized bronchodilator therapy is effective albeit complex during NIV and more studies are needed for optimum aerosol delivery.
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