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Research ArticleOriginal Research

Comparison of Vibrating Mesh, Jet, and Breath-Enhanced Nebulizers During Mechanical Ventilation

Sunya Ashraf, Michael McPeck, Ann D Cuccia and Gerald C Smaldone
Respiratory Care October 2020, 65 (10) 1419-1426; DOI: https://doi.org/10.4187/respcare.07639
Sunya Ashraf
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Stony Brook University Medical Center, Stony Brook, New York.
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  • For correspondence: [email protected]
Michael McPeck
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Stony Brook University Medical Center, Stony Brook, New York.
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Ann D Cuccia
State University of New York at Stony Brook, Department of Respiratory Care, Stony Brook, New York.
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Gerald C Smaldone
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Stony Brook University Medical Center, Stony Brook, New York.
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Abstract

BACKGROUND: This study compared 3 nebulizer technologies for inter- and intradevice reproducibility, humidification, and fill volume sensitivity during mechanical ventilation: a breath-enhanced jet nebulizer, a vibrating mesh nebulizer, and a jet nebulizer. The breath-enhanced jet nebulizer featured a new design located on the wet side of the humidifier to reduce aerosol loss and potential humidifier contamination. The vibrating mesh nebulizer and the jet nebulizer were placed on the dry side.

METHODS: Aerosol delivery was measured using multiple ventilator settings (inspiratory time = 0.45–1.01 s). Using radiolabeled saline and a gamma camera, bench studies were performed using a ventilator to test 4 breathing patterns. Four scenarios were assessed during testing: 3 mL and 6 mL fill volumes with and without heated wire humidification. Measurements included inhaled mass (as a percentage of the nebulizer charge), nebulizer residual, mass balance, and aerosol particle size distribution. Statistics were determined using Mann-Whitney and linear regression.

RESULTS: The inhaled mass for the breath-enhanced jet nebulizer was 10.5–29.2% and was affected by fill volume (P = .004) but not by humidity. The inhaled mass for the vibrating mesh nebulizer was 0.9–33% and was unaffected by fill volume and humidity. The inhaled mass for the jet nebulizer was 2.5–25.9% and was affected by both fill volume (P = .009) and humidity (3 mL, P = .002). The inhaled mass for the vibrating mesh nebulizer was more variable due to random failures to achieve complete nebulization, and inhaled mass correlated closely with residual mass: IM% = –0.233(Residual%) + 24.3, r2 = 0.67, P < .001. For all devices, large particles were lost in the ventilator tubing; large particles were also lost in the humidifier for the vibrating mesh nebulizer (17% nebulizer charge), resulting in similar particle distributions (mass median aerodynamic diameter 1.33–1.95 μm) for all devices.

CONCLUSIONS: Nebulization with the breath-enhanced jet nebulizer was less sensitive to humidification than the jet nebulizer. Delivery via the vibrating mesh nebulizer was not predictable, with random failure to empty (55% experimental runs). All devices delivered similar particle distributions. Wet-side aerosol delivery avoids humidifier contamination, and breath-enhanced technology can ensure better control of drug delivery.

  • aerosols
  • nebulizers and vaporizers
  • administration
  • inhalation
  • ventilators
  • mechanical
  • humidifiers
  • drug delivery
  • breath-enhanced

Footnotes

  • Correspondence: Sunya Ashraf MD. E-mail: sunya.ashraf{at}stonybrookmedicine.edu
  • See the Related Editorial on Page 1624

  • A version of this paper was presented at the Open Forum of the AARC Congress 2019, held November 9–12, 2019, in New Orleans, Louisiana.

  • This study was supported in part by InspiRx (Somerset, New Jersey). Dr Smaldone and Ms Cuccia have disclosed relationships with InspiRx Dr Ashraf and Mr McPeck disclosed no conflicts of interest.

  • Copyright © 2020 by Daedalus Enterprises
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Respiratory Care: 65 (10)
Respiratory Care
Vol. 65, Issue 10
1 Oct 2020
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Comparison of Vibrating Mesh, Jet, and Breath-Enhanced Nebulizers During Mechanical Ventilation
Sunya Ashraf, Michael McPeck, Ann D Cuccia, Gerald C Smaldone
Respiratory Care Oct 2020, 65 (10) 1419-1426; DOI: 10.4187/respcare.07639

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Comparison of Vibrating Mesh, Jet, and Breath-Enhanced Nebulizers During Mechanical Ventilation
Sunya Ashraf, Michael McPeck, Ann D Cuccia, Gerald C Smaldone
Respiratory Care Oct 2020, 65 (10) 1419-1426; DOI: 10.4187/respcare.07639
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Keywords

  • aerosols
  • nebulizers and vaporizers
  • administration
  • inhalation
  • ventilators
  • mechanical
  • humidifiers
  • drug delivery
  • breath-enhanced

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