Ipratropium Bromide (Atrovent) for Chest Phlegm in Children Post-Intubation
Ipratropium bromide (Atrovent) at a dose of 0.5 mg nebulized every 6 hours is recommended for managing chest phlegm in children post-intubation. 1
Dosing Recommendations by Age
- Children over 2-3 years: 250 micrograms (0.25 mg) per dose 2
- Children under 2-3 years: Maximum 125 micrograms (0.125 mg) delivered as nebulized solution 2
- Pre-term babies: Maximum 20 micrograms to avoid side effects 2
Administration Methods
Two effective delivery methods are available:
- Conventional nebulization: Traditional method shown to significantly reduce respiratory rate 3
- Metered-dose aerosol with spacer and mask: Equally effective as nebulization with added benefits:
- More convenient
- Requires less time and equipment
- Well-accepted by young patients
- May provide better reduction in transcutaneous carbon dioxide pressure 3
Clinical Benefits for Post-Intubation Phlegm
Ipratropium bromide works as a quaternary anticholinergic bronchodilator that:
- Reduces airway secretions
- Decreases respiratory rate
- Improves alveolar ventilation
- Reduces bronchospasm and recession in over 80% of treated children 3
Combination Therapy Considerations
For more severe cases, consider combination therapy:
- Ipratropium bromide plus beta-2 agonists (like salbutamol) provides greater improvement in respiratory mechanics than either agent alone 4
- The combination of 175 micrograms ipratropium with salbutamol showed the greatest decrease in respiratory system resistance (26%) 4
Important Considerations for Post-Extubation Care
- Airway humidification is recommended in ventilated children, though no specific type of humidification is superior 5
- Avoid routine saline instillation prior to endotracheal suctioning 5
- Maintain head elevation at 30-45° unless contraindicated 5
- Consider cough-assist techniques for patients with neuromuscular disease 5
Monitoring and Follow-up
- Monitor for clinical improvement in respiratory rate and work of breathing
- Assess for proper clearance of secretions
- For patients with underlying asthma, follow up within 24-48 hours after acute exacerbation 1
- Ensure proper inhaler technique if transitioning to inhaled therapy
Special Populations
- Infants with bronchopulmonary dysplasia: Ipratropium bromide is particularly useful in the first 18 months of life when beta-2 stimulants are rarely effective 2
- Approximately 40% of children with recurrent airways obstruction obtain significant benefit from ipratropium bromide 2
Ipratropium bromide is a safe and effective option for managing chest phlegm in children post-intubation, with minimal reported adverse effects when used appropriately according to age-specific dosing guidelines.