PT  - JOURNAL ARTICLE
AU  - Harnois, Lauren J
AU  - Alolaiwat, Amnah A
AU  - Jing, Guoqiang
AU  - Fink, James B
AU  - Dhand, Rajiv
AU  - Li, Jie
TI  - Efficacy of Various Mitigation Devices in Reducing Fugitive Emissions from Nebulizers
AID  - 10.4187/respcare.09546
DP  - 2022 Apr 01
TA  - Respiratory Care
PG  - 394--403
VI  - 67
IP  - 4
4099  - http://rc.rcjournal.com/content/67/4/394.short
4100  - http://rc.rcjournal.com/content/67/4/394.full
AB  - BACKGROUND: Fugitive aerosol concentrations generated by different nebulizers and interfaces in vivo and mitigation of aerosol dispersion into the environment with various commercially available devices are not known.METHODS: Nine healthy volunteers were given 3 mL saline with a small-volume nebulizer (SVN) or vibrating mesh nebulizer (VMN) with a mouthpiece, a mouthpiece with an exhalation filter, an aerosol mask with open ports for SVN and a valved face mask for VMN, and a face mask with a scavenger (Exhalo) in random order. Five of the participants received treatments using a face tent scavenger (Vapotherm) and a mask with exhalation filter with SVN and VMN in a random order. Treatments were performed in an ICU room with 2 particle counters positioned 1 and 3 ft from participants measuring aerosol concentrations at sizes of 0.3–10.0 μm at baseline, before, during, and after each treatment.RESULTS: Fugitive aerosol concentrations were higher with SVN than VMN and higher with a face mask than a mouthpiece. Adding an exhalation filter to a mouthpiece reduced aerosol concentrations of 0.3–1.0 μm in size for VMN and 0.3–3.0 μm for SVN (all P < .05). An Exhalo scavenger over the mask reduced 0.5–3.0 μm sized particle concentrations for SVN (all P < .05) but not VMN. Vapotherm scavenger and filter face mask reduced fugitive aerosol concentrations regardless of the nebulizer type.CONCLUSIONS: SVN produced higher fugitive aerosol concentrations than VMN, whereas face masks generated higher aerosol concentrations than mouthpieces. Adding an exhalation filter to the mouthpiece or a scavenger to the face mask reduced aerosol concentrations for both SVN and VMN. Vapotherm scavenger and filter face mask reduced fugitive aerosols as effectively as a mouthpiece with an exhalation filter. This study provides guidance for reducing fugitive aerosol emissions from nebulizers in clinical practice.