Performance Comparison of a Vibrating Mesh Nebulizer and Air Entrainment Jet Nebulizer in an Adult,Pediatric and Infant Spontaneously Breathing Model

Abstract

Background:

The air entrainment jet nebulizer (AEJN) is a type of jet nebulizer designed to deliver similar aerosol dose in less time and are marketed as a faster delivery device. Although time to deliver a dose may be a consideration in the selection of a device, more important factors include; delivered lung dose and patient clinical response. In vitro bench, imaging and clinical studies comparing jet nebulizer to vibrating mesh nebulizer (VMN) consistently demonstrate superior performance of VMN. We hypothesized that VMN would provide greater % tracheal dose compared to AEJN.

Methods:

Mask-mediated aerosol delivery with VMN (Aerogen Solo with Ultra, Aerogen Ltd., Galway, Ireland) and AEJN (Airlife Misty Fast, Carefusion Inc., Yorba Linda, CA) were compared in adult and pediatric models connected to a sinusoidal pump via a collecting filter at the level of the trachea. The following settings were used to simulate a spontaneously breathing adult (V_T 500 mL, 15 breaths/min, I:E ratio 1:1) and pediatric model (V_T 300 mL, 20 breaths/min, I:E ratio 1:2. The infant model utilized a blow-by interface held ½ inch from the upper airway of the spontaneously breathing lung model (V_T 50 mL, 30 breaths/min, I:E 1:3). The VMN was powered by the Pro-X controller with a driving gas flow of 2L/min from a 30 psi source (Aerogen, Galway, Ireland) and the AEJN powered by 8 L/min gas flow from a 30 psi source. The AEJN was loaded with a (2.5 mg/3 mL) solution of albuterol and aerosolized to sputter plus one minute and the VMN was run until aerosol was no longer produced (n = 4). Drug eluted from the filter was assayed with UV spectrophotometry (276 nm). Descriptive statistics and t-test were used for data analysis using SPSS. P < .05 was considered statistically significant.

Results:

The VMN resulted in significantly higher % tracheal dose compared to AEJN in adult and pediatric models (28.30 ± 0.62, vs 7.20 ± 0.22, P < .001 and 30.75 ± 2.18 vs 6.45 ± 0.59, P < .001, respectively). Percent tracheal dose with the blow by infant model was low with both VMN and JN (1.65 ± 0.79 vs 0.27 ± 0.10, respectively, P = .013). There was significantly less residual weight retained in the reservoir of the VMN (1.3%) compared to AEJN (43.6%) in all models tested, (P < .001).

Conclusions:

The VMN provided significantly greater % tracheal dose in the adult and pediatric models, 4-5-fold higher and significantly lower residual waste retained in the reservoir in all models tested when compared to AEJN.