PT - JOURNAL ARTICLE AU - Gerald Moody TI - Comparison of Vibrating Mesh Nebulizer Versus Jet Nebulizer in the Pediatric Asthma Patient: A Randomized Controlled Trial DP - 2019 Oct 01 TA - Respiratory Care PG - 3217971 VI - 64 IP - Suppl 10 4099 - http://rc.rcjournal.com/content/64/Suppl_10/3217971.short 4100 - http://rc.rcjournal.com/content/64/Suppl_10/3217971.full AB - Background: Jet nebulizers (JN) are commonly used in emergency departments to deliver bronchodilators in patients with acute asthma exacerbations. Vibrating mesh nebulizers (VMN) have been shown to be more efficient and deliver higher concentrations of medication compared to JN, but there have been no RCTs of VMN versus JN. The purpose of this study was to compare clinical outcomes related to using a VMN versus JN in the treatment of pediatric patients with acute moderate to severe asthma exacerbations. Methods: We conducted a single-blinded randomized controlled trial of 217 children (2-18 years old) who had a known history of asthma and presented to the emergency department with an acute moderate to severe exacerbation. Assessment of severity was defined by our acute asthma score (AS), adapted from Pediatric Asthma Score (PAS), which rates severity based on respiratory rate, oxygen requirement, retractions and findings on auscultation (Mild; 1-4, Moderate; 5-8, Severe; 9-12). Patients were randomized to receive treatment via VMN and valved mask or mouthpiece or standard JN with aerosol mask or mouthpiece, and were treated until they received a mild AS and discharged or until decision to admit. Patients were treated per our Acute Asthma Clinical Pathway Algorithm for ED with modifications to allow for blinding and assessment of treatment/dose response. Results: 108 patients were randomized to receive bronchodilator treatment via VMN and 109 via JN. There was significant difference in initial AS (P < .05) between the two study groups [VMN 9.0 (8.0 - 10.0) vs JN 8.0 (7.0 - 10.0)], but no other significant differences in demographics existed between groups. To adjust for the effect of initial AS, multiple logistic regression model was used to model admission. After adjustment of log-transformed AS and patient weight, patients treated with VMN had a higher probability to be discharged overall compared to patients treated with JN (P = 0.06), and in patients with mask interface, VMN significantly reduced the probability of admission (P = 0.03). The VMN group required significantly fewer treatments [2.0 (1.0 - 3.0) vs 3.0 (2.0 - 5.0), P < .001] and time to reach mild AS [58 mins (33 - 103) vs 81 mins (56 - 133), P = 0.004] compared to JN. Conclusions: Patients treated with VMN required significantly fewer treatments and time to achieve mild AS, and in patients with mask interface, VMN significantly reduced the probability of admission compared to JN.