From: Bronchodilator delivery with metered-dose inhaler during mechanical ventilation
Step | Details |
---|---|
1 | Place a spacer device in the inspiratory line of the ventilator |
 | circuit* (see Fig. 3) |
2 | Shake the MDI vigorously |
3 | Adapt the MDI to the spacer device |
4 | Remove the heat and moisture exchanger†(if used) |
5 | Do not change the ventilator settings‡ |
6 | Actuate MDI to synchronize with the onset of inspiratory flow |
7 | Repeat actuation after 20-30 s until the total dose is |
 | delivered |
8 | Start with four to six puffs and observe the response |
9 | Repeat bronchodilator treatment after 3-4 h§ |