Nebulizers have been used clinically for many years. Despite the increasing use of metered-dose inhalers and dry powder inhalers, it is likely that nebulizers will continue to be used in selected patients. A number of factors affect nebulizer performance, and these should be appreciated by clinicians who use these devices. Several new designs have recently become available that improve the performance of the nebulizer, but their cost-effectiveness remains to be determined.
AARC Clinical Practice Guideline. Selection of aerosol delivery device. American Association for Respiratory Care. Respir Care1992;37(8):891–897.
2.
O'DonohueWJJr. Guidelines for the use of nebulizers in the home and at domiciliary sites: report of a consensus conference. NAM- DRC Consensus Group. Chest1996;109(3):814–820.
3.
TurnerMO, GafniA, SwanD, FitzGeraldJM. A review and economic evaluation of bronchodilator delivery methods in hospital- ized patients. Arch Intern Med1996;156(18):2113–2118.
4.
CatesCJ. Holding chambers versus nebulizers for beta-agonist treatment of acute asthma. The Cochrane Database or Systematic Reviews, 1999.
5.
DalbyRN, TianoSL, HickeyAJ. Medical devices for the delivery of therapeutic aerosols to the lungs. In: HickeyAJ, editor. Inhala- tion aerosols: physical and biological basis for therapy. New York: Marcel Decker; 1996: 441–473.
6.
NewmanSP. Aerosol generators and delivery systems. Respir Care1991;36(9):939–951.
7.
DennisJH, HendrickDJ. Design characteristics for drug nebulizers. J Med Eng Technol1992;16(2):63–68.
8.
SmyeSW, JollieMI, LittlewoodJM. A mathematical model of some aspects of jet nebuliser performance. Clin Phys Physiol Meas1991;12(3):289–300.
9.
NivenRW, BrainJD. Some functional characteristics of air-jet nebulizers. Int J Pharm1994;104:73–85.
10.
NerbrinkO, DahlbackM, HanssonHC. Why do medical nebulizers differ in their output and particle size characteristics?J Aerosol Med1994;7:259–276.
11.
FullerHD, DolovichMB, ChambersC, NewhouseMT. Aerosol delivery during mechanical ventilation: a predictive in vitro lung model. J Aerosol Med1992;5:251–259.
12.
AARC Clinical Practice Guideline. Selection of device, administration of bronchodilator, and evaluation of response to therapy in mechanically ventilated patients. American Association for Respiratory Care. Respir Care1999;44(1):105–113.
13.
DiotP, MorraL, SmaldoneGC. Albuterol delivery in a model of mechanical ventilation: comparison of metered-dose inhaler and nebulizer efficiency. Am J Respir Crit Care Med1995;152(4 Pt 1):1391–1394.
14.
O'RiordanTG, GrecoMJ, PerryRJ, SmaldoneGC. Nebulizer func- tion during mechanical ventilation. Am Rev Respir Dis1992;145(5): 1117–1122.
15.
NivenRW. Atomization and nebulizers. In: HickeyAJ, editor. Inhalation aerosols: physical and biological basis for therapy. New York: Marcel Decker; 1996: 273–312.
PhippsPR, GondaI.Droplets produced by medication nebulizers: some factors affecting their size and solute concentration. Chest1990;97(6):1327–1332.
19.
WoodJA, WilsonRSE, BrayC.Changes in salbutamol concentra- tion in the reservoir solution of a jet nebulizer. Br J Dis Chest1986;80(2):164–169.
20.
StapletonKW, FinlayWH. Determining solution concentration within aerosol droplets output by jet nebulizers. J Aerosol Sci1995; 26:137–145.
21.
O'CallaghanC, ClarkeAR, MilnerAD. Inaccurate calculation of drug output from nebulisers. Eur J Pediatr1989;148(5):473–474.
22.
TandonR, McPeckM, SmaldoneGC. Measuring nebulizer output: aerosol production vs gravimetric analysis. Chest1997;111(5):1361- 1365.
23.
ClayMM, PaviaD, NewmanSP, Lennard-JonesT, ClarkeSW. Assessment of jet nebulisers for lung aerosol therapy. Lancet1983; 2(8350):592–594.
24.
Aerosol consensus statement—1991. American Association for Respiratory Care. Respir Care1991;36(9):916–921.
25.
HessD, FisherD, WilliamsP, PoolerS, KacmarekRM. Medication nebulizer performance: effects of diluent volume, nebulizer flow, and nebulizer brand. Chest1996;110(2):498–505.
26.
LoffertDT, IkleD, NelsonHS. A comparison of commercial jet nebulizers. Chest1994;106(6):1788–1792.
27.
AlvineGF, RodgersP, FitzsimmonsKM, AhrensRC. Disposable jet nebulizers. how reliable are they?Chest1992;101(2):316–319.
28.
HollieMC, MaloneRA, SkufcaRM, NelsonHS. Extreme variabil- ity in aerosol output of the DeVilbiss 646 jet nebulizer. Chest1991;100(5):1339–1344.
29.
LangfordSA, AllenMB. Salbutamol output from two jet nebuliz- ers. Respir Med1993;87(2):99–103.
30.
HoSL, CoatesAL. Effect of dead volume on the efficiency and the cost to deliver medications in cystic fibrosis with four disposable nebulizers. Can Respir J1999;6(3):253–260.
31.
CoatesAL, MacNeishCF, LandsLC, MeisnerD, KelemenS, VadasEB. A comparison of the availability of tobramycin for inhalation from vented vs unvented nebulizers. Chest1998;113(4): 951–956.
32.
ArossaW, QuagliottiF, SalaM, SpinaciS, De CandussioG.Dif- ferent performance of two commercial nebulizers. Respiration1984; 46(1):128–132.
33.
HessD, HorneyD, SnyderT.Medication-delivery performance of eight small-volume, hand-held nebulizers: effects of diluent vol- ume, gas flowrate, and nebulizer model. Respir Care1989;34(8): 717–723.
34.
HurleyPK, SmyeSW, CunliffeH.Assessment of antibiotic aerosol generation using commercial jet nebulizers. J Aerosol Med1994; 7(3):217–228.
35.
SmaldoneGC, PerryRJ, DeutschDG. Characteristics of nebulizers used in the treatment of AIDS-related pneumocystis carinii pneu- monia. J Aerosol Med1988;1:113–126.
36.
WaldrepJC, KeyhaniK, BlackM, KnightV.Operating character- istics of 18 different continuous-flow jet nebulizers with beclometha- sone dipropionate liposome aerosol. Chest1994;105(1):106–110.
37.
Hartley-SharpeCJ, BoothH, JohnsDP, WaltersEH. Differences in aerosol output and airways responsiveness between the DeVilbiss 40 and 45 hand held nebulisers. Thorax1995;50(6):635–638.
38.
MacNeishCF, MeisnerD, ThibertR, KelemenS, VadasEB, CoatesAL. A comparison of pulmonary availability between Ventolin (al- buterol) nebules and Ventolin (albuterol) Respirator Solution. Chest1997;111(1):204–208.
39.
CoatesAL, MacNeishCF, MeisnerD, KelemenS, ThibertR, Mac- DonaldJ, VadasE.The choice of jet nebulizer, nebulizing flow, and addition of albuterol affects the output of tobramycin aerosols. Chest1997;111(5):1206–1212.
40.
NewmanSP, WoodmanG, ClarkeSW. Deposition of carbenicillin aerosols in cystic fibrosis: effects of nebuliser system and breathing pattern. Thorax1988;43(4):318–322.
41.
O'DohertyM, ThomasS, PageC, BradbeerC, NunanT, BatemanN.Pulmonary deposition of nebulised pentamidine isethionate: ef- fect of nebuliser type, dose, and volume of fill. Thorax1990;45(6): 460–464.
42.
HardyJG, NewmanSP, KnochM.Lung deposition from four nebulizers. Respir Med1993;87(6):461–465.
43.
JohnsonMA, NewmanSP, BloomR, TalaeeN, ClarkeSW. De- livery of albuterol and ipratropium bromide from two nebulizer systems in chronic stable asthma: efficacy and pulmonary deposi- tion. Chest1989;96(1):6–10.
44.
StandaertTA, MorlinGL, Williams-WarrenJ, JoyP, PepeMS, We- berA, RamseyBW. Effects of repetitive use and cleaning tech- niques of disposable jet nebulizers on aerosol generation. Chest1998;114(2):577–586.
45.
KradjanWA, LakshminarayanS.Efficiency of air compressor- driven nebulizers. Chest1985;87(4):512–516.
46.
HadfieldJW, WindebankWJ, BatemanJRM. Is driving gas flow rate clinically important for nebulizer therapy?Br J Dis Chest1986; 80(1):50–54.
47.
ClayMM, PaviaD, NewmanSP, ClarkeSW. Factors influencing the size distribution of aerosols from jet nebulisers. Thorax1983; 38(10):755–759.
48.
EverardML, ClarkAR, MilnerAD. Drug delivery from jet nebu- lisers. Arch Dis Child1992;67(5):586–591.
49.
FlamentMP, LetermeP, BurnoufT, GayotA.Influence of formu- lation on jet nebulisation quality of alpha 1 protease inhibitor. Int J Pharm1999;178(1):101–109.
50.
HessDR, AcostaFL, RitzRH, KacmarekRM, CamargoCAJr. The effect of heliox on nebulizer function using a beta-agonist bron- chodilator. Chest1999;115(1):184–189.
51.
MartonenT, YangY.Deposition mechanics of pharmaceutical par- ticles in human airways. In: HickeyAJ, editor. Inhalation aerosols: physical and biological basis for therapy. New York: Marcel Deck- er; 1996: 3–27.
52.
SmaldoneGC. Drug delivery via aerosol systems: concept of "aero- sol inhaled". J Aerosol Med1991;4(3):229–235.
53.
SteventonRD, WilsonRSE. Facemask or mouthpiece for delivery of nebulized bronchodilator aerosols?Br J Dis Chest1981;75(1): 88–90.
54.
EverardML, HardyJG, MilnerAD. Comparison of nebulised aero- sol deposition in the lungs of healthy adults following oral and nasal inhalation. Thorax1993;48(10):1045–1046.
55.
LowenthalD, KattanM.Facemasks versus mouthpieces for aerosol treatment of asthmatic children. Pediatr Pulmonol1992;14(3):192- 196.
56.
Smedsaas-LofvenbergA, NilssonK, MoaG, AxelssonI.Nebuli- zation of drugs in a nasal CPAP system. Acta Paediatr1999;88(1): 89–92.
57.
ParkesSN, BerstenAD. Aerosol kinetics and bronchodilator effi- cacy during continuous positive airway pressure delivered by face mask. Thorax1997;52(2):171–175.
58.
KairaitisK, GarlickSR, WheatleyJR, AmisTC. Route of breathing in patients with asthma. Chest1999;116(6):1646–1652.
59.
MelchorR, BiddiscombeMF, MakVHF, ShortMD, SpiroSG. Lung deposition patterns of directly labelled salbutamol in normal subjects and in patients with reversible airflow obstruction. Thorax1993;48(5):506–511.
60.
PaviaD, ThompsonML, ClarkeSW, ShannonHS. Effect of lung function and mode of inhalation on penetration of aerosol into the human lung. Thorax1977;32(2):194–197.
61.
LipworthBJ, ClarkeDJ. Effects of airway calibre on lung delivery of nebulised salbutamol. Thorax1997;52(12):1036–1039.
62.
SwiftDL, CarpinJC, MitznerW.Pulmonary penetration and dep- osition of aerosols in different gases: fluid flow effects. Ann Occup Hyg1982;26(1-4):109–117.
63.
SvartengrenM, AndersonM, PhilipsonK, CamnerP.Human lung deposition of particles suspended in air or in helium/oxygen mix- ture. Exp Lung Res1989;15(4):575–585.
64.
EschJL, SpecktorDM, LippmannM.Effect of lung airway branch- ing pattern and gas composition on particle deposition: II. Experi- mental studies in human and canine lungs. Exp Lung Res1988; 14(3):321–348.
65.
AndersonM, SvartengrenM, BylinG, PhilipsonK, CamnerP.Deposition in asthmatics of particles inhaled in air or in helium- oxygen. Am Rev Respir Dis1993;147(3):524–528.
66.
AndersonM, SvartengrenM, PhiliosonK, CamnerP.Deposition in man of particles suspended in air or in helium-oxygen mixture at different flow rates. J Aerosol Med1990;3:209–216.
67.
HendersonSO, AcharyaP, KilaghbianT, PerezJ, KornCS, ChanLS. Use of heliox-driven nebulizer therapy in the treatment of acute asthma. Ann Emerg Med1999;33(2):141–146.
68.
PollackCVJr, FleischKB, DowseyK.Treatment of acute bron- chospasm with beta-adrenergic agonist aerosols delivered by a na- sal bilevel positive airway pressure circuit. Ann Emerg Med1995; 2(65):552–557.
69.
DhandR, TobinMJ. Bronchodilator delivery with metered-dose inhalers in mechancically ventilated patients. Eur Respir J1996;9: 585–595.
70.
DhandR, TobinMJ. Inhaled bronchodilator therapy in mechani- cally-ventilated patients (review). Am J Respir Crit Care Med1997; 156(1):3–10.
71.
MantousCA, HallJB. Administration of therapeutic aerosols to mechanically ventilated patients (review). Chest1994;106(2):560- 571.
72.
HessD.Inhaled bronchodilators during mechanical ventilation: de- livery techniques, evaluation of response, and cost-effectiveness. Respir Care1994;39(2):105–122.
HanhanU, KissoonN, PayneM, TaylorC, MurphyS, DeNicolaLK. Effects of in-line nebulization on preset ventilatory variables. Respir Care1993;38(5):474–478.
77.
MarikP, HoganJ, KrikorianJ.A comparison of bronchodilator therapy delivered by nebulization and metered-dose inhaler in me- chanically ventilated patients. Chest1999;115(6):1653–1657.
78.
DennisJH. A review of issues relating to nebulizer standards. J Aerosol Med1998;11Suppl 1:S73–S77.
79.
PisutFM. Comparison of medication delivery by T-nebulizer with inspiratory and expiratory reservoir. Respir Care1989;34(11):985- 988.
80.
MarshallLM, FrancisPW, KhafagiFA. Aerosol deposition in cys- tic fibrosis using an aerosol conservation device and a conventional jet nebulizer. J Paediatr Child Health1994;30(1):65–67.
81.
ThomasSH, LangfordJA, GeorgeRDG, GeddesDM. Improving the efficacy of drug administration with jet nebulizers (letter). Lan- cet1988;1(8577):126.
82.
PiperSD. In vitro comparison of the Circulaire and AeroTee to a traditional nebulizer T-Piece with corrugated tubing. Respir Care2000;45(3):313–319.
83.
MasonJW, MillerWC, SmallS.Comparison of aerosol delivery via Circulaire system vs conventional small volume nebulizer. Re- spir Care1994;39(12):1157–1161.
84.
MasonJW, MillerWC. Comparison of aerosol delivery via circu- laire nebulizer system versus a disposable nebulizer in COPD pa- tients. Respir Care1996;41(11):1006–1008.
85.
HoffmanL, SmithlineH.Comparison of Circulaire to conventional small volume nebulizer for the treatment of bronchospasm in the emergency department. Respir Care1997;42(12):1170–1174.
86.
NewnhamDM, LipworthBJ. Nebuliser performance, pharmacoki- netics, airways and systemic effects of salbutamol given via a novel nebuliser system ("Venstream"). Thorax1994;49(8):762–770.
87.
NewmanSP, PitcairnGR, HooperG, KnochM.Efficient drug delivery to the lungs from a continuously operated open-vent neb- ulizer and low pressure compressor system. Eur Respir J1994;7(6): 1177–1181.
88.
DevadasonSG, EverardML, LintoJM, Le SouefPN. Comparison of drug delivery from conventional versus "Venturi" nebulizers. Eur Respir J1997;10(11):2479–2483.
89.
BarryPW, O'CallaghanC.The output of budesonide from nebu- lizers. J Allergy Clin Immunol1998;102(2):321–322.
90.
SuezDS, ChaiH.A standard method of intermittent inhaled ther- apy via a jet nebulizer. Ann Allergy1986;57(4):245–248.
91.
McPeckM, O'RiordanTG, SmaldoneGC. Choice of mechanical ventilator: influence on nebulizer performance. Respir Care1993; 38(8):887–895.
92.
HughesJM, SaezJ.Effects of nebulizer mode and position in a mechanical ventilator circuit on dose efficiency. Respir Care1987; 32(12):1131–1135.
93.
PortnoyJ, AggarwalJ.Continuous terbutaline nebulization for the treatment of severe exacerbations of asthma in children. Ann Al- lergy1988;60(4):368–371.
94.
MolerFW, HurwitzME, CusterJR.Improvement in clinical asthma score and PaCO2 in children with severe asthma treated with con- tinuously nebulized terbutaline. J Allergy Clin Immunol1988;81(6): 1101–1109.
95.
CalacaconeA, WolkoveN, SternE, AfilaloM, RosentalTM, Kre- ismanH.Continuous nebulization of albuterol (salbutamol) in acute asthma. Chest1990;97(3):693–697.
96.
PapoMC, FrankJ, ThompsonAE. A prospective, randomized study of continuous versus intermittent nebulized albuterol for severe status asthmaticus in children. Crit Care Med1993;21(10):1479- 1486.
97.
LinRY, SauterD, NewmanT, SirleafJ, WaltersJ, TavakolM.Continuous versus intermittent albuterol nebulization in the treat- ment of acute asthma. Ann Emerg Med1993;22(12):1847–1853.
98.
RudnitskyGS, EberleinRS, SchoffstallJM, MazurJE, SpiveyWH. Comparison of intermittent and continuosly nebulized albuterol for treatment of asthma in an urban emergency department. Ann Emerg Med1993;22(12):1842–1846.
99.
LinRY, SmithAJ, HergenroederP.High serum albuterol levels and tachycardia in adult asthmatics treated with high-dose contin- uously aerosolized albuterol. Chest1993;103(1):221–225.
100.
KatzRW, KellyHW, CrowleyMR, GradR, McWilliamsBC, MurphySJ. Safety of continuously nebulized albuterol for bron- chospasm in infants and children. Pediatrics1993;92(5):666–669.
101.
OlshakerJ, JerrardD, BarishRA, BrandtG, HooperF.The efficacy and safety of a continuous albuterol protocol for the treatment of acute adult asthma attacks. Am J Emerg Med1993;11(2):131–133.
102.
ReisnerC, KotchA, DworkinG.Continuous versus frequent in- termittent nebulization of albuterol in acute asthma: a randomized, prospective study. Ann Allergy Asthma Immunol1995;75(1):41- 47.
103.
MolerFW, JohnsonCE, Van LaanenC, PalmisanoJM, NasrSZ, AkingbolaO.Continuous versus intermittent nebulized terbutaline: plasma levels and effects. Am J Respir Crit Care Med1995;151(3 Pt 1):602–606.
104.
ShresthaM, BidadiK, GourlayS, HayesJ.Continuous vs inter- mittent albuterol, at high and low doses, in the treatment of severe acute asthma in adults. Chest1996;110(1):42–47.
105.
BakerEK, WillsieSK, MarinacJS, SalzmanGA. Continuously nebulized albuterol in severe exacerbations of asthma in adults: a case controlled study. J Asthma1997;34:521–530.
106.
WeberEJ, LevittMA, CovingtonJK, GambrioliE.Effect of con- tinuously nebulized ipratropium bromide plus albuterol on emer- gency department length of stay and hospital admission rates in patients with acute bronchospasm: a randomized, controlled trial. Chest1999;115(4):937–944.
107.
PortnoyJ, NadelG, AmadoM, Willsie-EdigerS.Continuous neb- ulization for status asthmaticus (review). Ann Allergy1992;69(1): 71–79.
108.
VossKR, Willsie-EdigerSK, PyszczynskeDR, NelsonKA. De- scription of a delivery method for continuously aerosolized albu- terol in status asthmaticus. J Asthma1990;27(1):37–39.
109.
ChippsBE, BlackneyDA, BlackLE, MoodyRR, MarinoJT, RidellRC, WongGA. Vortran high output extended aerosol respiratory therapy (HEART) for delivery of continuously nebulized terbutal- ine for the treatment of acute bronchospasm. Pediatr Asthma Al- lergy Immunol1990;471-277.
110.
BerlinskiA, WaldrepJC. Four hours of continuous albuterol neb- ulization. Chest1998;114(3):847–853.
111.
ReisnerC, LeeJ, KotchA, DworkinG.Comparison of volume output from two different continuous nebulizer systems. Ann Al- lergy Asthma Immunol1996;76(2):209–213.
112.
RaabeOG, WongTM, WongGB, RoxburghJW, PiperSD, LeeJI. Continuous nebulization therapy for asthma with aerosols of beta2 agonists. Ann Allergy Asthma Immunol1998;80(6):499–508.
113.
McPeckM, TandonR, HughesK, SmaldoneGC. Aerosol delivery during continuous nebulization. Chest1997;111(5):1200–1205.
114.
CorkeryKJ, LuceJM, MontgomeryAB. Aerosolized pentamidine for treatment and prophylaxis of Pneumocystis carinii pneumonia: an update. Respir Care1988;33(8):676–685.
115.
VinciguerraC, SmaldoneG.Treatment time and patient tolerance for pentamidine delivery by Respirgard II and AeroTech II. Respir Care1990;35(11):1037–1041.
116.
MatthysH, HercegR.Dosing strategies for aerosol delivery to the lung parenchyma, with specific recommendations for pentamidine. Respir Care1991;36(9):989–993.
117.
DemersRR, ParkerJ, FrankelLR, SmithDW. Administration of ribavirin to neonatal and pediatric patients during mechanical ven- tilation. Respir Care1986;31(12):1188–1195.
118.
American Academy of Pediatrics Committee on Infectious Dis- eases. Use of ribavirin in the treatment of respiratory syncytial virus infection. Pediatrics1993;92(3):501–504.
119.
SmithDW, FrankelLR, MathersLH, TangAT, AriagnoRL, ProberCG. A controlled trial of aerosolized ribavirin in infants receiving mechanical ventilation for severe respiratory syncytial virus infec- tion. N Engl J Med1991;325(1):24–29.
120.
KacmarekRM, KratohvilJ.Evaluation of a double-enclosure dou- ble-vacuum unit scavenging system for ribavirin administration. Respir Care1992;37(1):37–45.
121.
CharneyW, CorkeryKJ, KraemerR, WugofskiL.Engineering and administrative controls to contain aerosolized ribavirin: results of simulation and application to one patient. Respir Care1990;35(11): 1042–1048.
122.
WahlinB, MalmstromB, SoopM, HellstromLG. A pediatric can- opy system for aerosol administration and minimized environmen- tal pollution. Acta Anaesthesiol Scand1996;40(8 Pt 1):932–939.
123.
StevensHR, AlbregtHB. Assessment of ultrasonic nebulization. Anesthesiology1966;27(5):648–653.
124.
ModellJH, GiammonaST, DavisJH. Effect of chronic exposure to ultrasonic aerosols on the lung. Anesthesiology1967;28(4):680- 688.
125.
DennisJH, StentonSC, BeachJR, AveryAJ, WaltersEH, HendrickDJ. Jet and ultrasonic nebuliser output: use of a new method for direct measurement of aerosol output. Thorax1990;45(10):728- 732.
126.
NewmanSP, PellowGD, ClarkeSW. In vitro comparison of DeVilbiss jet and ultrasonic nebulizers. Chest1987;92(6):991–994.
127.
FokTF, LamK, NgPC, SoHK, CheungKL, WongW, SoKW. Randomised crossover trial of salbutamol aerosol delivered by me- tered-dose inhaler, jet nebuliser, and ultrasonic nebuliser in chronic lung disease. Arch Dis Child Fetal Neonatal Ed1998;79(2):F100- F104.
128.
BallardRD, BoginRM, PakJ.Assessment of bronchodilator re- sponse to a beta-adrenergic delivered from an ultrasonic nebulizer. Chest1991;100(2):410–415.
129.
NakanishiAK, LambBM, FosterC, RubinBK. Ultrasonic nebu- lization of albuterol is no more effective than jet nebulization for the treatment of acute asthma in children. Chest1997;111(6):1505- 1508.
130.
LarsenKR, SvendsenUG, MolgaardF, PetersenBN. Comparabil- ity of albuterol delivered by a piezoelectric device versus metered- dose inhaler in patients with chronic obstructive airways disease. J Aerosol Med1998;11(2):81–88.
131.
OlivensteinR, WolkoveN, CohenC, FrankH, KreismanH.A comparison of responses to albuterol delivered by two aerosol de- vices. Chest1986;90(3):392–395.
132.
EisenbergJ, PepeM, Williams-WarrenJ, VasilievM, MontgomeryAB, SmithAL, RamseyBW. A comparison of peak sputum tobra- mycin concentration in patients with cystic fibrosis using jet and ultrasonic nebulizer systems. Aerosolized Tobramycin Study Group. Chest1997;111(4):955–962.
133.
O'RiordanTG, AmramJC. Effect of nebulizer configuration on de- livery of aerosolized tobramycin. J Aerosol Med1997;10(1):13–23.
134.
WeberA, MorlinG, CohenM, Williams-WarrenJ, RamseyB, SmithA.Effect of nebulizer type and antibiotic concentration on device performance. Pediatr Pulmonol1997;23(4):249–260.
135.
WeberA, SmithA, Williams-WarrenJ, RamseyB, CovertDS. Nebulizer delivery of tobramycin to the lower respiratory tract. Pediatr Pulmonol1994;17(5):331–339.
136.
HarveyCJ, O'DohertyMJ, PageCJ, ThomasSHL, NunanTO, TreacherDF. Comparison of jet and ultrasonic nebulizer pulmonary aerosol deposition during mechanical ventilation. Eur Respir J1997; 10(4):905–909.
137.
ThomasSH, O'DohertyMJ, PageCJ, TreacherDF, NunanTO. Delivery of ultrasonic nebulized aerosols to a lung model during me- chanical ventilation. Am Rev Respir Dis1993;148(4 Pt 1):872–877.
138.
KemmingGI, KreylingW, HablerO, MerkelM, KleenM, WelteM, et al.Aerosol production and aerosol droplet size distribution during mechanical ventilation (IPPV) with a new ultrasonic nebu- lizer. Eur J Med Res1996;1(7):321–327.
139.
WilliamsL, FletcherGC, DanielM, KinsellaJ.A simple in vitro method for the evaluatin of an ultrasonic nebulizer for drug delivery to intubated, ventilated patients and the effect of nebulizer and ventilator settings on the uptake of fluid from the nebulizer cham- ber. Eur J Anaesthesiol1999;16(7):479–484.
140.
GreenspanBJ. Ultrasonic and electrohydrodynamic methods for aerosol generation. In: HickeyAJ, editor. Inhalation aerosols: phys- ical and biological basis for therapy. New York: Marcel Decker; 1996: 313–335.
141.
GaleAE. Drug degeneration during ultrasonic nebulization. J Aero- sol Sci1985;16:265.
