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Answer -- First of
all, there's nothing magical about giving a 10 or 15 minute
treatment. If you can administer the requisite amount of
drug in less time, you can safely reduce the time it takes to
perform the treatment. Arguably, a shorter treatment
does not induce as much fatigue in the acutely ill patient and
may encourage better adherence to the treatment regime in
chronic patients. The
results of a study being
presented in the Open Forum of the AARC International Congress
in December 2003 points out that the Medicator®
delivers 2.1 times as much albuterol as the Circulaire®
and 1.4 times as much as the standard "tee"
nebulizer system. Further, the Medicator®
delivered 1.8 times as much albuterol in 6 minutes as the
Circulaire® and "tee." So, you could simply
cut treatment time with the Medicator® to 4-5 minutes and still deliver more drug than the other systems
deliver.
Another way
would be to use undiluted albuterol in the
Medicator® and offset the higher concentration by
reducing treatment time. And rather than
fill the nebulizer from a multi-dose vial, which would present
an unsatisfactory infection control risk, you could enjoy the
convenience of using
Nephron Pharmaceuticals unit-of-use plastic ampoules of 0.5%
albuterol. By
loading the nebulizer with four 0.5 mL vials of 0.5%
albuterol, you
will be able to administer three timed 2-minute “high
dose” albuterol treatments of
approximately 0.75 mg each from
a single nebulizer charge. This
is a useful protocol that is consistent with the NHLBI asthma
guidelines for the Emergency Department treatment of acute
exacerbation of asthma Not
only will this "speed up" the treatment (reduce the
treatment time), but it will save money and help you reduce concurrent
therapy. We
have studied albuterol delivery for this protocol in the lab are working on
writing it up. Stay tuned to this web site where we will publish a
detailed "Protocol for Undiluted Albuterol" in the
near future. |
