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

Administration of inhaled bronchodilators during mechanical ventilation is technically challenging, and data on the use of long-acting agents in this setting remain limited.

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 ($\overline{P}$_aw), respiratory system resistance (R_RS), tidal volumes (V_Ti and V_Te), and the $S_{{\mathrm{pO}}_2}$/$F_{{\mathrm{IO}}_2}$.

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 $\overline{P}$_aw (P = .067) and $S_{{\mathrm{pO}}_2}$/$F_{{\mathrm{IO}}_2}$ (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.

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.