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Research ArticleOriginal Research

Efficacy of Various Mitigation Devices in Reducing Fugitive Emissions from Nebulizers

Lauren J Harnois, Amnah A Alolaiwat, Guoqiang Jing, James B Fink, Rajiv Dhand and Jie Li
Respiratory Care April 2022, 67 (4) 394-403; DOI: https://doi.org/10.4187/respcare.09546
Lauren J Harnois
Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, Illinois.
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Amnah A Alolaiwat
Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, Illinois.
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Guoqiang Jing
Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, Shandong, China.
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James B Fink
Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, Illinois; and Aerogen Pharma, San Mateo, California.
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Rajiv Dhand
Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee.
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Jie Li
Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, Illinois.
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  • For correspondence: [email protected]
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    Fig. 1.

    Study setup. The study participant was seated on a sofa chair with particle counters positioned at 1 and 3 ft from the participant at mouth level. The study investigator stayed in the room with the participant, with N95 mask worn throughout the study. With permission.

  • Fig. 2.
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    Fig. 2.

    Different devices to reduce fugitive aerosol concentrations. SVN = small-volume nebulizer. A mouthpiece with an expiratory filter: VMN (A) and SVN (E); face mask with exhalation filters: VMN (B) and SVN (F); Exhalo scavenger with an aerosol face mask: VMN (C) and SVN (G); Vapotherm scavenger with an aerosol face mask: VMN (D) and SVN (H). With permission.

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    Fig. 3.

    Mean fugitive aerosol concentrations of VMN versus SVN with mouthpiece and face mask at 1 ft from participants. A and B: SVN had higher fugitive aerosol concentrations than VMN with particle sizes of 1.0–5.0 µm for mask (A) and 1.0–3.0 µm for mouthpiece (B). C and D: Mask had higher fugitive aerosol concentrations than mouthpiece with particle sizes of 0.5–3.0 µm for VMN (D) whereas no differences for SVN (C). SVN = small-volume nebulizer. VMN = vibrating mesh nebulizer. *P < .05.

  • Fig. 4.
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    Fig. 4.

    Comparison of fugitive aerosol concentrations at 1 and 3 ft from participants. When an aerosol face mask was utilized with nebulizers, fugitive aerosol concentrations were higher at 1 ft from participants than at 3 ft with A: VMN at particle sizes of 0.3 µm, and B: SVN at particle sizes of 3.0 µm. * P < .05.

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    Fig. 5.

    Mean fugitive aerosol concentrations of a mouthpiece with an expiratory filter and a face mask with Exhalo scavenger at 1 ft from participants. A and B: Compared to using mouthpiece alone, adding an expiratory filter to a mouthpiece significantly reduced fugitive aerosol concentrations with A: particle sizes of 0.3–3.0 µm for SVN and B: 0.3–1.0 µm for VMN. C and D: Compared to using aerosol mask alone, using the Exhalo scavenger with the aerosol mask significantly reduced fugitive aerosol concentrations with C: particle sizes of 0.5–3.0 µm for SVN, whereas D: no differences were observed for VMN. SVN = small-volume nebulizer. VMN = vibrating mesh nebulizer. * P < .05.

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    Fig. 6.

    Comparisons of Vapotherm scavenger and filter face mask to reduce fugitive aerosols generated by nebulizer and face mask at 1 ft from participants. A: Fugitive aerosol concentrations with particle sizes of 0.3–10.0 µm with the use of SVN; B: fugitive aerosol concentrations with particle sizes of 0.3–10.0 µm with the use of VMN. *P < .05. SVN = small-volume nebulizer. VMN = vibrating mesh nebulizer. When SVN with an aerosol mask was utilized, fugitive aerosol concentrations with particle sizes of 0.3–3.0 µm were lower with Vapotherm scavenger, filter mask, and mouthpiece with a filter, which had similar effectiveness to reduce fugitive aerosol concentrations and higher effectiveness than Exhalo scavenger. When VMN with an aerosol mask was utilized, fugitive aerosol concentrations with particle sizes of 0.3–1.0 µm were lower with Vapotherm scavenger, filter mask, and mouthpiece with a filter, which had similar effectiveness to reduce fugitive aerosol concentrations. Whereas slightly lower fugitive aerosol concentration with mouthpiece and filter than Exhalo scavenger was only found at particle size of 1.0 µm.

  • Fig. 7.
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    Fig. 7.

    Participant self-evaluated comfort while breathing with different devices. SVN = small-volume nebulizer. VMN = vibrating mesh nebulizer. The devices with the highest comfort scores were VMN with a filter mask, VMN with a mouthpiece and a filter, and SVN with a filter mask. Whereas the 2 devices with mean comfort score below 3.0 are VMN with an aerosol mask and VMN with an aerosol mask and Exhalo scavenger. During the use of VMN, the comfort was higher with the mouthpiece and a filter than the valved face mask with Exhalo scavenger (P = .047).

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Respiratory Care: 67 (4)
Respiratory Care
Vol. 67, Issue 4
1 Apr 2022
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Efficacy of Various Mitigation Devices in Reducing Fugitive Emissions from Nebulizers
Lauren J Harnois, Amnah A Alolaiwat, Guoqiang Jing, James B Fink, Rajiv Dhand, Jie Li
Respiratory Care Apr 2022, 67 (4) 394-403; DOI: 10.4187/respcare.09546

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Efficacy of Various Mitigation Devices in Reducing Fugitive Emissions from Nebulizers
Lauren J Harnois, Amnah A Alolaiwat, Guoqiang Jing, James B Fink, Rajiv Dhand, Jie Li
Respiratory Care Apr 2022, 67 (4) 394-403; DOI: 10.4187/respcare.09546
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  • nebulization
  • fugitive aerosol
  • aerosol generation procedure
  • aerosol transmission

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