Abstract:
BACKGROUND:In mechanically ventilated patients with COPD, the response of the expiratory resistance of the respiratory system (expiratory R(RS)) to bronchodilators is virtually unknown. OBJECTIVE:To examine the effect of inhaled albuterol on expiratory R(RS), and the correlation of albuterol-induced changes in expiratory R(RS) with end-inspiratory resistance and the expiratory flow-volume relationship. METHODS:We studied 10 mechanically ventilated patients with COPD exacerbation, before and 30 min after administration of albuterol. We obtained flow-volume curves during passive expiration, divided the expired volume into 5 equal volume slices, and then calculated the time constant and dynamic effective deflation compliance of the respiratory system (effective deflation C(RS)) of each slice via regression analysis of the volume-flow and post-occlusion volume-tracheal pressure relationships, respectively. For each slice we calculated expiratory R(RS) as the time constant divided by the effective deflation C(RS). RESULTS:Albuterol significantly decreased the expiratory R(RS) (mean expiratory R(RS) 42.68 ± 17.8 cm H(2)O/L/s vs 38.08 ± 16.1 cm H(2)O/L/s) and increased the rate of lung emptying toward the end of expiration (mean time constant 2.51 ± 1.2 s vs 2.21 ± 1.2 s). No correlation was found between the albuterol-induced changes in expiratory R(RS) and that of end-inspiratory resistance. Only at the end of expiration did albuterol-induced changes in the expiratory flow-volume relationship correlate with changes in expiratory R(RS) in all patients. CONCLUSIONS:In patients with COPD, albuterol significantly decreases expiratory resistance at the end of expiration. In mechanically ventilated patients, neither inspiratory resistance nor the whole expiratory flow-volume curve may be used to evaluate the bronchodilator response of expiratory resistance.
journal_name
Respir Carejournal_title
Respiratory careauthors
Kondili E,Alexopoulou C,Prinianakis G,Xirouchaki N,Vaporidi K,Georgopoulos Ddoi
10.4187/respcare.00984subject
Has Abstractpub_date
2011-05-01 00:00:00pages
626-32issue
5eissn
0020-1324issn
1943-3654pii
rc00984r2kondilijournal_volume
56pub_type
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