Can MDIs be used effectively by extubated ICU patients?

Metered-dose inhaler (MDI) therapy can be an effective, cost-efficient means of managing chronic airway obstruction in many patients in medical or surgical intensive care units who have recently been extubated. Because medication is delivered directly to the airways through an MDI, a relatively low dosage may be effective, and few adverse effects may be encountered. Candidates for MDI therapy should have a vital capacity of at least 900 mL, be able to hold their breath for at least 5 seconds, and have a respiratory rate of under 25 breaths per minute. The majority of patients who meet these criteria are able to convert to MDI therapy within 24 hours of extubation.