I am currently looking in to the effects of administering aerosolized bronchodilators to patients that are not having bronchospasms. If anyone has information concerning this phenomenon, contact me at zwcr4@goldmail.etsu.edu
Thanks
Craig
links:
ETSU Home Page www.etsu.edu
AARC - American Association for Respiratory Care www.aarc.org
E.T.S.U. Respiratory Therapy Home Page http://www.etsu.edu/CPAH/DAHS/Cardiopulmonary_Science/
Video link about respiratory therapy http://www.aarc.org/career/
Article Critique
In reviewing the article titled Bronchodilator Therapy in Mechanically Ventilated Patients: Patient Selection and Clinical Outcomes found in the Feb. 2007 edition of the online journal Respiratory Care: The Science Journal of the American Association for Respiratory Care Volume 52 number 2, pages 152-153, The article offered a synopsis of a study found in the same edition of the journal. The general evaluation of this piece was very good and I chose it due to the relevance to the research topic I have chosen and my field of study and future vocation. I would highly suggest this brief appraisal of an important topic for both students and instructors; the pure educational value was concise and written to a level that would pique the interest of students to pursue more information on the topic and would be a great discussion topic for motivated instructors. This editorial would make a poor choice for patient education due to the technical nature of the presentation. I found the readability of this piece to be again, technical with a good amount of editorial comment to increase the ease of reading. This article is an editorial of a study that examined the use of bronchodilators in patients that had no history of obstructive lung disease while they were intubated and on mechanical ventilatory support. The article begins by reviewing what beneficial effects bronchodilators can have on patients suffering from obstructive airway disease, including reducing wheezing, improving vital signs and other hemodynamic measurements, reducing airway resistance and making patient feel less short of breath. The evaluation continues by mentioning the possible adverse reactions associated with bronchodilator therapy and states the parameters of the study. It was noted that prior studies have established that airway resistance increases when a subject is mechanically ventilated and furthermore/therefore, the administration of bronchodilators to these patients is commonplace. While the article states that no significant improvement in patient outcome was established with this first of its kind study, the subject is well worth examining and also suggests ways and methods to develop additional studies. The first of three things that I was unfamiliar with that this article brought to my attention was that high dose/continuous bronchodilator therapy can induce low levels of serum potassium and thereby lead to potential cardiac consequences. This imbalance occurs due to the intracellular shift or trade off with sodium that is encouraged by Beta 2 agonists. Second, I did not realize that mechanical ventilation leads to an increase in airway resistance. While I knew that the endotracheal tube will lead to increased resistance, I had never thought of the ventilator itself doing the same thing. This occurs due to the nature of mechanical ventilation causing more turbulent flow than a normal breath which the flow rate can be automatically adjusted not only with every breath but during each breath. The increased turbulence increases the work of breathing, and decreased effectiveness of each breath. Finally, I something that I did not know was that this was the first study to address this question with respect to bronchodilator therapy in mechanically ventilated patients. The article could have probed further and offered more detail for me (so I wouldn’t have to) but I found that brevity also as a strength in that it was concise enough to convey the important aspects of the study. I will be able to add this critique to my collection of study/research material that investigates why we give drugs to people that clinically do not need them.
Craig Reed