Bronchodilator therapy in mechanically ventilated patients: patient selection and clinical outcomes.

Bronchodilators are among the most commonly employed drugs in the intensive care unit. Inhaled bronchodilator therapy is preferred in modern practice because of many advantages over systemic therapy.1 In patients with airflow obstruction, inhaled bronchodilators improve wheezing2 and hemodynamics3 and reduce airway resistance and intrinsic positive end-expiratory pressure.4,5 Bronchodilators also reduce the work of breathing,6 and they could reduce the sensation of dyspnea while improving patient-ventilator interaction. In addition, bronchodilators could facilitate weaning in patients with limited cardiopulmonary reserve.6 Combining 2 adrenergic and anticholinergic bronchodilators has a greater effect than therapy with either agent alone.7 Generally, use of inhaled bronchodilators in mechanically ventilated patients is quite safe. When a higher-thanrecommended dose of bronchodilator is employed, the patient could develop hypokalemia8 or cardiac arrhythmia.8,9 Paradoxical bronchoconstriction could also occur. Moreover, the cost of bronchodilator therapy, particularly in terms of time spent by respiratory therapists for bronchodilator administration, is a major consideration.10