RT refused to give NEB! - page 3

At our facility, RT administers all nebs. We have a patient who is in with aspiration pneumonia. His O2 sat was in low 80s and was in distress. He asked for a treatment, which was amazing because... Read More

  1. by   MunoRN
    Quote from usalsfyre
    If the patients unable to properly use an MDI, then they need a neb. Otherwise an MDI is a cheaper option that more closely matches what they will most likely use at home.

    As for the levalbuterol vs albuterol, the Xopenex is vastly more expensive with little to no clinical benefit.
    In patients experiencing asthma or COPD exacerbations, particularly older COPD patients, the difference in xopenex vs racemic albuterol is signficant, including decreased inpatient admission rates when used in the ED, shorter lengths of stay, lower 30-day readmission rates, lower rates of adverse effects such as paradoxical bronchospasm, decreased beta effects (due to decreased total dosage), and decreased overall use.

    The main study that critics of xopenex point to is the Quereshi et al study. This study was done on mild to moderate severity asthma exacerbations in young patients, which is not the target group for xopenex. The study also was seriously flawed in the use of steroid therapy as a control. Racemic albuterol contains both the (R) and (S) isomers of albuterol. The (S) isomer was once thought to be inert, although once we gained the ability to separate (R) and (S) albuterol and perform research on each isomer, it became clear that the (S) isomer exerts pro-inflammatory effects, which explains why xopenex, which is only (R) albuterol is more effective even at lower doses than racemic albuterol with the same amount of the "active" ingredient (R) albuterol; the pro-inflammatory (S) albuterol is working against the anti-inflammatory effects of (R) albuterol. Essentially, racemic albuterol is a poison and an antidote packaged together. Using a steroid as a control is like testing the effects of a poison while using the antidote as a control and then declaring the poison is not poisonous after all.

    There once was a time when xopenex was much more expensive than racemic albuterol, although probably still cheaper when you consider admission rates and lengths of stay, although levalbuterol is now generic, making the price difference about $3 a day.
  2. by   MunoRN
    Quote from usalsfyre
    If the patients unable to properly use an MDI, then they need a neb. Otherwise an MDI is a cheaper option that more closely matches what they will most likely use at home.
    Matching the patient's home routine is fine if the patient is admitted for something other than what they take the bronchodilator for. What's really frustrating, for Nurses MD's and patients, is when RT puts a patient on their home routine who was just admitted for a COPD exacerbation. Obviously their home routine wasn't sufficient, if it was they could have just stayed at home. What really frustrates patients is that in the ED they get xopenex (our ED doesn't even stock racemic albuterol), then come to the floor and go back to racemic MDI's and usually lose any progress they made in the ED.

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