Richard Branson on bronchodilators (#SCCM2023)
clear standard of care for bronchoconstriction, but mostly used for hypoxemic disease because it "can't hurt". Ehrmann 2013 European survey found 95% used them routinely in mechanically ventilated
clear standard of care for bronchoconstriction, but mostly used for hypoxemic disease because it "can't hurt". Ehrmann 2013 European survey found 95% used them routinely in mechanically ventilated
BALTI trial: IV B-agonists for ALI improved resolution of alveolar edema and survival
Perkins 2014: salmeterol didn't improve ALI
BALTI-2: salbutamol, stopped for harm
Perkins 2014: salmeterol didn't improve ALI
BALTI-2: salbutamol, stopped for harm
Routine nebs create significant workload and disposable equipment burden
Device types vary by efficiency, but we use so much drug it likely doesn't matter - it gets delivered.
Device types vary by efficiency, but we use so much drug it likely doesn't matter - it gets delivered.
Kondili 2021: albuterol improves expiratory resistance but no real impact on inspiratory resistance.
Fleming 2023: aerosol treatments in their health system were half not evidence based, 6.7 FTEs of workload. Education/QI initiative was able to reduce neb use dramatically
Fleming 2023: aerosol treatments in their health system were half not evidence based, 6.7 FTEs of workload. Education/QI initiative was able to reduce neb use dramatically
Overall: B agonists have no impact on positive ARDS outcomes, only negative ones. Stop it!
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