Quality Improvement Project to Compare Vibrating Mesh Nebulizer Therapy With Hour Long Jet Nebulizer Therapy for Albuterol Delivery in Asthma and Reactive Airway Disorder Patients in a Pediatric Emergency Department

Abstract

Background: The jet nebulizer (JN) and vibrating mesh nebulizer (VMN) are used to treat children with asthma and reactive airway disorder (RAD) in the emergency department (ED) setting. Imaging data demonstrates greater aerosol delivery to the lung with VMN compared to JN. There is no data comparing clinical outcomes of JN vs. VMN in the pediatric ED setting. The purpose of our study was to compare albuterol delivery with a large volume JN versus VMN to determine the effect on outcomes in pediatric patients with asthma and RAD exacerbations in the ED. Methods: The study was a prospectively designed chart review to compare 90-day treatment periods from December to March for two consecutive years (2018 and 2019) in pediatric asthma and RAD patients (2–18 y old) seen in the ED for an acute exacerbation. Patients weighing less than 20 kg received 2.5 mg albuterol and patients weighing greater than 20 kg received 5 mg albuterol with a VMN with a valved holding chamber (Aerogen Solo with Ultra, Aerogen, Galway, Ireland) instead of an hour- long weight based dose between 5 and 20 mg delivered with a large volume JN (Airlife Misty Finity Large Volume Nebulizer, Carefusion, Yorba Linda, CA). Primary outcome was the total amount of albuterol (mg) administered. Secondary outcomes included total number of treatments, ED length of stay (LOS) before discharge or disposition, admission rate, and 48-hour ED readmission rate. IRB approval was obtained. Data was extracted from Meditech and analyzed with independent sample t-tests. Results: Patient data was evaluated in year one JN (608, mean age 6.24 ± 3.64) and year two VMN (537, mean age 6.43 ± 3.81) resulting in a mean dose of 11.23 mg ± 5.21 and 3.72 mg ± 1.28 respectively (P < .001). Mean number of treatments administered in JN group compared to the VMN group was 1.52 ± 0.72 and 1.45 ± 0.64 (P < .001). Admissions decreased in the VMN group by 41% (JN 158, VMN 81). Return to the ED in 48 hours decreased in the VMN group by 42% (JN 29, VMN 15). ED LOS decreased by an average of 80 minutes. Conclusions: Use of the VMN in the pediatric ED setting significantly decreased the total amount of albuterol and number of treatments administered compared to large volume JN. Admission rates, 48-hour readmission rates and ED LOS were lower in the VMN group compared to the JN group. Randomized controlled trials are needed to support these findings. Disclosures: Authors have no commercial relationships.