Drug Study on Salbutamol (Ventolin) for Respiratory Failure Type II
For patients with type II respiratory failure, nebulized salbutamol (2.5-5 mg) should be administered via air-driven nebulizer (not oxygen) every 4-6 hours, with careful monitoring of arterial blood gases to prevent worsening carbon dioxide retention. 1
Generic and Brand Names
- Generic: Salbutamol (International), Albuterol (US)
- Brand names: Ventolin, Proventil 2
Mode of Action
- Relatively selective beta2-adrenergic bronchodilator that relaxes bronchial smooth muscle
- Reduces airway resistance and improves airflow through bronchioles
- Onset of action within 5-15 minutes, with peak effect at 30-60 minutes 3, 4
Indications
- Acute exacerbations of COPD with bronchospasm
- Management of bronchospasm in respiratory failure
- Relief of bronchospasm in patients with reversible obstructive airway disease 1
Contraindications
- Hypersensitivity to salbutamol or any component of the formulation
- Caution in patients with cardiovascular disorders, especially coronary insufficiency and hypertension
- Caution in patients with convulsive disorders or hyperthyroidism 2
Suggested Dose for Respiratory Failure Type II
- Initial dose: 2.5-5 mg salbutamol via nebulization
- Frequency: Every 4-6 hours or until clinical improvement is observed
- For severe cases: Consider combined treatment with ipratropium bromide 500 μg 1
Drug Interactions
- Beta-blockers: Antagonize the effects of salbutamol
- MAO inhibitors and tricyclic antidepressants: May potentiate cardiovascular effects
- Other sympathomimetic agents: May have additive effects
- Diuretics: Possible enhanced hypokalemic effect 5
Side Effects
- Tremor, particularly affecting the hands
- Tachycardia, palpitations
- Headache, dizziness
- Nervousness, restlessness
- Hypokalemia (with high doses) 4, 6
Adverse Effects
- Paradoxical bronchospasm (rare but serious)
- Significant tachycardia or arrhythmias
- Severe hypokalemia
- Lactic acidosis (rare)
- Worsening hypoxemia due to ventilation-perfusion mismatch 4, 7
10 Nursing Responsibilities with Rationale
Assess respiratory status before and after administration - To establish baseline and evaluate treatment effectiveness 1
Monitor arterial blood gases - Critical in type II respiratory failure to detect worsening carbon dioxide retention 1
Use air (not oxygen) to drive nebulizer - Oxygen may worsen hypercapnia in type II respiratory failure patients 1
Monitor vital signs, especially heart rate - Tachycardia is a common side effect that requires monitoring 5
Check electrolytes, particularly potassium levels - High doses can cause hypokalemia 4
Maintain proper nebulizer technique - Ensures optimal drug delivery to the lower airways 1
Position patient upright during nebulization - Maximizes lung expansion and medication distribution 1
Clean nebulizer equipment properly after each use - Prevents infection and ensures proper functioning 1
Document response to treatment - Helps evaluate effectiveness and guide future treatment decisions 1
Educate patient about possible side effects - Improves compliance and reduces anxiety about expected effects like tremor 1
Special Considerations for Type II Respiratory Failure
In patients with carbon dioxide retention and acidosis, the nebulizer must be driven by air, not oxygen, to prevent worsening hypercapnia 1
Combined treatment with ipratropium bromide (250-500 μg) should be considered in more severe cases, especially if the patient has had a poor response to salbutamol alone 1, 5
Continuous monitoring of respiratory parameters is essential as these patients are at risk for respiratory depression 3, 4
For mechanically ventilated patients, salbutamol administration can improve respiratory mechanics by decreasing airway resistance 4