Vibrating mesh nebulizer delivers more aerosol than jet nebulizer in the
pediatric patient
Abstract
Objective: To assess in vitro nebulized drug delivery during
invasive and non-invasive ventilation models, comparing jet and
vibrating mesh nebulizers. Aimed to compare differences in absolute
inhaled dose, delivery rate and residual volume in various pediatric
ventilation models with either face mask, mechanically ventilated, high
flow nasal therapy or blow-by methods utilizing approved nebulizer
locations. Methods: Compared drug delivery performance of a
continuous output jet nebulizer (JN) with a vibrating mesh. The
non-invasive model simulated a spontaneously breathing 9-month-old child
using an anatomically correct model of upper airways and breathing
simulator. The intubated model consisting of a mechanical ventilator
with a heated humidifier in a pediatric breathing circuit and
endotracheal tube. A JN (Aquineb), driven with 6 L·min
-1 or a VMN (Aerogen Solo) driven with 2 L·min
-1 supplemental oxygen were assessed by dose, delivery
rate and residual volume. Drug dose was quantified using
spectrophotometric analysis. Results: During normal spontaneous
breathing, VMN dose was almost double that of JN ( P <
0.001), while delivery rate by VMN was also quicker, ( P
< 0.001). Residual volume was significantly higher using JN (
P < 0.0001). During mechanical ventilation, VMN had a
greater than 3-fold dose ( P < 0.0001), while the rate
of delivery by VMN was also quicker ( P < 0.0001).
Residual volume was also significantly greater using JN ( P
< 0.001) during ventilation. During HFNT, aerosol delivery via
nasal cannula was shown to be affected by gas flow rate for both VMN and
JN, with again VMN delivering a greater dose over JN .
Salbutamol delivery was also significantly greater using VMN for blow-by
delivery. Conclusion: This study demonstrates significantly
increased dose and rate of delivery, and significantly decreased
residual volumes post-nebulization for airway deposition using a VMN
compared to JN. Use of VMNs could improve drug delivery in pediatric
populations, potentially altering the clinical course.