Critical Care Scenarios Lightning rounds 59: The nuances of nebulizers, with Keith Lamb
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Jan 14, 2026 Delve into the world of nebulizers and their vital role in inpatient care. Discover why nebulizers often outperform inhalers in patients with dyspnea. Learn about continuous albuterol therapy and the logistics behind it. Hear contrasting insights on small-volume vs. vibrating mesh nebulizers and their efficiency. Explore the complexities of dose, dilution, and optimal delivery methods. Join a lively debate on the role of bronchodilators in secretion clearance and the importance of tailored therapy for better resource stewardship.
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Prefer Inhalers For Stable, Nebs For Dyspneic
- Use inhalers for cooperative, stable inpatients and nebulizers for dyspneic or altered patients who cannot coordinate inhaler use.
- Favor inhalers at discharge for cost and independence, but switch to nebs if the patient is acutely short of breath.
Inhalers Don't Belong On Ventilators
- Inhalers on ventilators or noninvasive support perform poorly and can waste large sums and staff time.
- Keith Lamb recommends against using inhalers on ventilated or noninvasive patients due to cost and ineffectiveness.
Default Q6; Escalate For Exacerbations
- Schedule routine bronchodilator nebs about every six hours and escalate to Q4–Q2 for acute reactive airway exacerbations.
- Use more frequent albuterol than ipratropium when escalating because albuterol is safer to repeat.