This has appeared in the ancient Question 12 from the second paper of 2002. The candidates were asked to "compare and contrast the methods of delivery of beta-2 agonists in intubated patients". The college does not limit themselves to nebulisation; however this is the most common method, and will be the focus of this chapter.
LITFL has a good page about it, which does into some detail regarding the various types of nebuliser, and their relative merits.
Prior to reading Question 12 from the second paper of 2002, I was not aware that beta-2 agonists could be given subcutaneously. Turns out, people have done this to infants, and "no local or general adverse reactions were observed".
A table of comparison is offered, as it is essentially the tabulated form of the college's own model answer.
Features |
Metered dose inhaler |
Nebuliser |
Intravenous |
Advantages |
Cheap Easy to set up Lowest toxicity Does not break the circuit |
Cheap Low toxicity |
Certainty regarding dose delivery No need to break the circuit |
Disadvantages |
Spacer adds dead space into the circuit Drug precipitation occurs in the upper airways and the tubing Needs to be timed with ventilator breaths Unreliable drug delivery to the site of action |
Drug precipitation occurs in the upper airways and the tubing Unreliable drug delivery to the site of action |
Greatest toxicity
|
Thomas, S. H., et al. "Pulmonary deposition of a nebulised aerosol during mechanical ventilation." Thorax 48.2 (1993): 154-159.
Dhand, Rajiv. "Basic techniques for aerosol delivery during mechanical ventilation." Respiratory care 49.6 (2004): 611-622.