Should IV Ventolin be considered for suspected H1N1 patients?

[rock_shoes]

Not alot of compelling evidence out there. Terbutaline is still a decent medication but had its place in the spotlight in the late 70s and 80s where a couple of your studies are from. However, there have been several articles showing albuterol or salmeterol to be more effective.

I think your right. Terbutaline is just the first medication that I started to look at in greater depth. There's more to come for sure.

Again, there are going to be some factors to consider if this is to be used on flu patients. Unless they have bronchospasm from an underlying pulmonary hx, IV may not be as effective nor would a bronchodilator be always indicated with PNA or infiltrates with ARDS.

Again, absolutely true. If past flu's are any indication I expect a huge portion of patients requiring hospitalization and or presenting in respiratory distress will have underlying pulmonary history exacerbated by H1N1.

Also, if the patient is experiencing all the flu symptoms, you may have dehydration, hypovolemia, tachycardia and electrolyte imbalances to consider before introducing something IV such as Ventolin which is already noted for hypokalemia and known for Diabetes Mellitus exacerbations. Either medication can enhance the overall presenting situation. Thus, for flu patients, working with a filtered neb (or MDI) and the provider wearing the N95 mask may be a better alternative to target specific receptor sites and minimalize systemic side affects.

Excellent point. I think this really strikes at the heart of the matter. Flu patients could easily be hypokalemic already. Giving such a patient medication with significant potential to cause hypokalemia could concievably have drastic negative effects on the patient's condition. I'm with you in thinking filtered administration devices will be the better solution. This has really turned into a good exercise in research for me which is why I've continued to gather information.

Now for the asthmatic patient, that might be beneficial. However, the literature has so far no proven the benefits across a broad range for even the countries where IV Ventolin is an option.

Given the increased risk of adverse effects which is proven, I think IV administration would have to prove to be more effective (which has yet to be shown in most cases). I think this is the reason IV administration thus far has been reserved for the more severe exacerbations where the patient's airway is so far shut down inhaled administration is not viable. What would be interesting is a comparison between IV Ventolin and administering enough epi for inhaled routes to become viable in the event of status asthmaticus.

Here is a fairly recent (2002) study for pediatrics:

http://findarticles.com/p/articles/mi_m0689/is_7_51/ai_88999791/?tag=content;col1

Interesting study. Looks like IV Ventolin should remain on the docket for further study based on those results.

Edited October 10, 2009 by rock_shoes

[VentMedic]

Here's another study with sabutamol It does help with the search when you enter the name for the drug most commonly used in countries other than the U.S.

Intravenous salbutamol bolus compared with an aminophylline infusion in children with severe asthma: a randomised controlled trial

Thorax 2003;58:306-310; doi:10.1136/thorax.58.4.306

http://thorax.bmj.com/cgi/content/abstract/58/4/306

Unfortunately I'm not coming up with too many recent articles.

However, here is a very recent article on SARS and MDIs. There was a lot learned from SARS and most of it was what was done wrong or could have been done better especially for the respiratory isolation issues. But then other parts of the world don't always have the expertise of Respiratory Therapists.

http://www.rcjournal.com/contents/07.09/07.09.0855.pdf

Edited October 10, 2009 by VentMedic

[rock_shoes]

Here's another study with sabutamol It does help with the search when you enter the name for the drug most commonly used in countries other than the U.S.

Intravenous salbutamol bolus compared with an aminophylline infusion in children with severe asthma: a randomised controlled trial

Thorax 2003;58:306-310; doi:10.1136/thorax.58.4.306

http://thorax.bmj.com/cgi/content/abstract/58/4/306

Unfortunately I'm not coming up with too many recent articles.

I've been having the same problem finding more recent research. The shorter length of hospital admission this particular study shows with aminophylline is promising but definitely in need of longer study before any final conclusions can be made.

However, here is a very recent article on SARS and MDIs. There was a lot learned from SARS and most of it was what was done wrong or could have been done better especially for the respiratory isolation issues. But then other parts of the world don't always have the expertise of Respiratory Therapists.

http://www.rcjournal.com/contents/07.09/07.09.0855.pdf

This article does an excellent job of illustrating how modifying care provider opinions can be a huge part of the battle. I have very little experience with MDI+spacer use. It just isn't the currently used standard of care in my area. Based on clearly proven results MDI+spacer use is getting an undeserved bad rap. I think one of the reasons nebulizers seem to get all the glory is because it looks like you're doing more. Nebulizers are also really easy for a care provider. Put the medication in the bowl, apply the mask, and set the flow rate to run the neb. Where I think nebulizers still have an advantage is that they allow a provider to give humidified oxygen concurrently.

[tniuqs]

This article does an excellent job of illustrating how modifying care provider opinions can be a huge part of the battle. I have very little experience with MDI+spacer use. It just isn't the currently used standard of care in my area. Based on clearly proven results MDI+spacer use is getting an undeserved bad rap. I think one of the reasons nebulizers seem to get all the glory is because it looks like you're doing more. Nebulizers are also really easy for a care provider. Put the medication in the bowl, apply the mask, and set the flow rate to run the neb. Where I think nebulizers still have an advantage is that they allow a provider to give humidified oxygen concurrently.

Agreed the Ontario EMS and even TO ICUs were caught with there pants down ... live and learn, as for Spacers and MDI the Galaxo studies suggest that this was a superior method of delivery with radioactive partial trace. I have many queries about that study BUT that said with the possibility of increasing volume of airborne infected partials it becomes a no brainer really ... now back to the thread IMHO IV salbutamol this is a damn big hammer and unless one is predisposed to Asthmatic response and is in status and extremus there are other ways to treat, intubated and on vaporizer circuits now here aminophyllyne has gone the way of the dodo bird due to the very "tight" therapeutic margin and cardiovascular collapse is a real consideration, that said a GREAT reversal agent with persantine challenges.

Big thing right now (kinda off topic) is availability of inoculations (maybe some time late October ???) in Canada (thats like wheeling the Trojen Hourse in the front gate and closing the door AND then compliance issue with the all HCW .... I will be the FIRST kid on my block to be standing in that line.

cheers

ps and dont get me going on humidified O2 from a bubble humidifier ... thats a joke ... really really.

Edited October 11, 2009 by tniuqs