Page 464 - Clinical Application of Mechanical Ventilation

430 Chapter 13

TABLE 13-7 Corticosteroids for Systemic Use

Drug Route of Administration

Hydrocortisone Oral, IV

Cortisone Oral
Prednisolone Oral

Dexamethasone Oral, IV
Prednisone Oral

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superinfections, patients should be instructed to rinse and gargle the mouth after
each treatment. MDI corticosteroids are rarely used during mechanical ventilation.
There are many serious adverse effects associated with systemic corticosteroid
therapy. Abrupt withdrawal following long-term systemic therapy may cause serious
complications from adrenal insufficiency. Recovery time varies depending on the
dosage and duration of therapy. Another serious effect is an increased susceptibility
to opportunistic infections.

Clinical Considerations. Corticosteroids are not bronchodilators. Their use in the
Corticosteroids may be treatment of bronchospasm is limited to situations where patients have lost beta ag-
used when other traditional
bronchodilators have failed to onist responsiveness or when other bronchodilators have failed. Their primary role
relieve bronchospasm. is in the management of long-term airway inflammation. Systemic corticosteroids
should be used cautiously with patients receiving steroidal-based neuromuscular
blocking agents (vecuronium bromide and pancuronium bromide) because of the
potential of prolonged neuromuscular weakness (Kupfer et al., 1987).

DELIVERy OF MDI MEDICATIONS

Many bronchodilators and steroids come in a metered-dose inhaler (MDI). With
proper adaptor or fittings, MDI medications may be administered via the ventila-
Delivery of MDI medica- tor circuit without interruption to mechanical ventilation or airway pressure. The
tions during mechanical
ventilation can be enhanced actuation of an MDI in a ventilator circuit must be synchronized with the onset of
by synchronization of inspiratory flow. A slight delay (e.g., 1 to 1.5 sec) after the onset of inspiratory flow
actuation of MDI with onset
of inspiratory flow, a tidal can significantly reduce the amount of drug delivery. A tidal volume of 500 mL or
volume of 500 mL or more, a more, a longer inspiratory time, and a slower inspiratory flow improve drug delivery
longer inspiratory time, and a
slower inspiratory flow. to the lower respiratory tract and lungs (Dhand, 2005).
MDI may be given with a right-angle adaptor or with a spacer. Studies have
shown that an MDI with spacer is a more efficient method for delivering in-
haled medications to the lungs than the right-angle MDI port (Marik, Hogan &
Krikorian, 1999; Mouloudi, Katsanoulas & Anastasaki et al., 1998). The efficacy
of MDI drug delivery does not improve with end-inspiratory pause during de-
livery (Mouloudi et al., 1998) or use of different inspiratory flow pattern during

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