Use of a Shared Canister Protocol for the Delivery of Metered-Dose Inhalers in Mechanically Ventilated Subjects.
BACKGROUND: Mechanically ventilated patients often need bronchodilators administered via a metered-dose inhaler (MDI). Unfortunately, there are no data examining the impact of shared canister delivery of MDI therapy in mechanically ventilated patients. METHODS: A prospective trial was conducted with...
| Publicado en: | Respiratory Care Vol. 61; no. 10; pp. 1285 - 1293 |
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| Autores principales: | , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Oct2016
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=118570220&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 118570220 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Oct2016 vid: 61 iid: 10 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 118570220 118570220 118570220 10.4187/respcare.04550 118570220 ppf: 1285 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Use of a Shared Canister Protocol for the Delivery of Metered-Dose Inhalers in Mechanically Ventilated Subjects. aug: au: Gowan, Mollie Bushwitz, Jennifer Watts, Peggy Silver, Patty C. Jackson, Mark Hampton, Nicholas Kollef, Marin H. affil: Department of Pharmacy, Bames-Jewish Hospital, St. Louis, Missouri sug: subj: Respiration, Artificial Nebulizers and Vaporizers Protocols Ventilator Patients Bronchodilator Agents Administration and Dosage Human Descriptive Statistics Prospective Studies Outcome Assessment Pneumonia, Ventilator-Associated Diagnosis Hospital Mortality Length of Stay Ventilators, Mechanical Adverse Effects Multiple Logistic Regression Costs and Cost Analysis Prevalence Cost Benefit Analysis Missouri T-Tests Mann-Whitney U Test APACHE (Acute Physiology and Chronic Health Evaluation) Clinical Assessment Tools P-Value Confidence Intervals Odds Ratio Chi Square Test Fisher's Exact Test Relative Risk Treatment Duration Male Female Middle Age Aged Funding Source Middle Aged: 45-64 years Aged: 65+ years Male Female ab: BACKGROUND: Mechanically ventilated patients often need bronchodilators administered via a metered-dose inhaler (MDI). Unfortunately, there are no data examining the impact of shared canister delivery of MDI therapy in mechanically ventilated patients. METHODS: A prospective trial was conducted with subjects assigned to shared canister MDI therapy or single-patient canister MDI therapy. Outcomes assessed were occurrence of ventilator-associated pneumonia (VAP), hospital mortality, length of stay, ventilator-associated events, and MDI costs. RESULTS: Among 486 screened patients, 353 were included for analysis of which 201 (56.9%) received shared canister MDI therapy and 152 (43.1%) received single-patient canister therapy. VAP (7.0% vs 4.6%, P = .35), hospital mortality (21.9% vs 20.4%, P = .73), and ventilator days (median [interquartile range] 3.1 [0.9-7.5] d vs 2.7 [ 1-2-7.1] d, P = .62) were similar between the shared canister and single-patient canister groups. We did not observe clinically important differences for ventilator-associated events between study groups in our logistic regression analysis (P = .07). There was a savings of $217/subject in the shared canister group due to the use of 299 fewer MDIs. CONCLUSIONS: Our study found that shared canister MDI therapy compared with single-patient MDI use was associated with a significant cost savings and similar rates of VAP, hospital mortality, and length of stay but a greater prevalence of ventilator-associated events. This finding suggests that shared canister delivery of MDIs may be a cost-effective practice in mechanically ventilated patients. Based on our findings, further studies examining the overall safety of shared canister use in mechanically ventilated patients seem warranted before recommending their routine use. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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