Respiratory Mechanics After Inline Delivery of Tiotropium/Olodaterol During Mechanical Ventilation

Abstract

Background: Administration of inhaled bronchodilators during mechanical ventilation is technically challenging, and data on the use of long-acting agents in this setting remain limited. Methods: In this prospective study, 23 hemodynamically stable COPD subjects receiving mechanical ventilation and considered ready for weaning were enrolled. Tiotropium/olodaterol (2.5/2.5 µg, 2 puffs) was delivered via an inline adapter. Outcomes included peak inspiratory pressure (PIP), plateau pressure (P plat ), mean airway pressure ( P ¯ aw ), respiratory system resistance (R RS ), tidal volumes (V Ti and V Te ), and the S pO 2 / F IO 2 . Results: The median age was 76 years (interquartile range, 48–90), with 82.6% male subjects and 69.6% classified as GOLD stage 3 to 4. Compared with baseline, statistically significant changes occurred in PIP ( P < .001), P plat ( P = .041), R RS ( P = .004), and ventilator-measured V Ti ( P = .02) and V Te ( P = .006). Variations in P ¯ aw ( P = .067) and S pO 2 / F IO 2 ( P = .14) were not statistically significant. In exploratory subgroup analyses, greater changes in tidal volumes were observed in male subjects (V Ti and V Te ), subjects younger than 65 years (V Ti ), and those with a tracheostomy (V Te ). No hemodynamic instability or treatment-related discontinuations were observed. Conclusions: Inline delivery of tiotropium/olodaterol during mechanical ventilation was feasible and was associated with changes in respiratory mechanics in COPD subjects. Given the observational design and absence of a control group, these findings should be interpreted as physiologic observations rather than evidence of treatment efficacy.