A patient on mechanical ventilation was given 4 puffs of albuterol 5 min ago through a metered dose inhaler (MDI) and holding chamber placed 18 in from the circuit's airway connector

The patient continues to exhibit clinical signs of increased airway resistance but has demonstrated no apparent side effects from the drug. Which of the following would you recommend at this time?
a. Discontinue the albuterol and switch to a systemic bronchodilator.
b. Repeat administration until the desired response is achieved.
c. Remove the circuit-holding chamber and repeat MDI actuation.
d. Move the MDI closer to the patient's air-way and repeat use.

ANS: B
Box 39-9 outlines the optimal technique for drug delivery by pressurized MDI to intubated pa-tients undergoing mechanical ventilation.