The Science Journal of the American Association for Respiratory Care

1998 OPEN FORUM Abstracts

CLINICAL EVALUATION OF CIRCULAIRE^{TM} (CIRC) VS CONVENTIONAL SMALL VOLUME NEBULIZER (SVN) FOR THE TREATMENT OF ACUTE BRONCHOSPASM ASSOCIATED WITH ASTHMA OR ASTHMATIC BRONCHITIS IN AN EMERGENCY DEPARTMENT.

Rebecca L. Meredith, RRT, Phyllis L. Bajusz, RRT. The Cleveland Clinic Foundation, Cleveland, Ohio.

Background: The Circulaire^{TM} nebulizer incorporates a reservoir bag, one-way valve, and variable resistor into the system. Through these features it has been shown to produce smaller particles enabling greater pulmonary and less pharyngeal deposition. Therefore, it should decrease systemic side effects, improve bronchodilitation, and ultimately decrease the length of stay (LOS) in the emergency department (ED). The aim of this randomized, single-blind clinical trial was to compare the effect of the two devices on: peak expiratory flow rate (PEFR), heart rate (HR), respiratory rate (RR), ED length of stay (LOS), and discharge disposition. Method: The study took place at an inner-city, tertiary referral center. The sample was comprised of 137 patients presenting to the ED with a primary diagnosis of asthma or asthmatic bronchitis and peak expiratory flow rate (PEFR) < 80% of the national standard based on age and height. Patients received Albuterol 5.0mg with SVN nebulized for 10 minutes (N=68) or CIRC for 6 minutes (N=69). Variables included demographics; diagnosis; PEFR, HR, and RR before/after each treatment; hours in ED (LOS); and discharge disposition. Between group analyses were conducted using Chi square tests for categorical variables and Mann-Whitney U tests for ordinal level variables. Results: The groups were comparable on age, gender, and diagnosis. The table presents change in PEFR, HR, and RR before and after the first and second treatment.

Treatment (TX1)

SVN (N=68) CIRC (N=69)

[filled triangle]PEFR (L/min) 44.60 ± 53.3 75.1 ± 65.7*

[filled triangle]HR (/min.) 0.94 ± 10.50 3.2 ± 12.2

[filled triangle]RR (/min.) 0.79 ± 3.5 1.6 ± 3.1

Treatment (TX1) TX2

SVN (N=57) CIRC (N=59)

[filled triangle]PEFR (L/min) 17.7 ± 31.6 36.9 ± 45.8**

[filled triangle]HR (/min.) 3.0 ± 7.9 8.2 ± 9.6 ++

[filled triangle]RR (/min.) 0.21 ±2.4 0.17 ±2.4

* p=0.002 ** p=0.006 ++ p=0.001

The rate of change in PEFR was significantly greater for the CIRC group compared to the SVN group after the first and second treatment. The change in heart rate was significantly higher for the CIRC group after the second treatment. No significant differences occurred between the two groups in change of respiratory rate. The LOS was significantly shorter for the CIRC group (1.6 ± 0.8 vs 2.2 ± 1.2, p=0.0004). Although not statistically significant, there was a trend toward a greater percentage of the SVN group requiring hospital admission (10% vs 6.9%, p= 0.09). Conclusion: We found CIRC to be superior to SVN as evidenced by: improved PEFR after the first and second treatments; decreased length of stay in the emergency department; and a trend toward fewer hospital admissions. Despite the increased HR after the second treatment with CIRC, the benefits outweigh the risks.

The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.

You are here: RCJournal.com » Past OPEN FORUM Abstracts » 1998 Abstracts » CLINICAL EVALUATION OF CIRCULAIRE^{TM} (CIRC) VS CONVENTIONAL SMALL VOLUME NEBULIZER (SVN) FOR THE TREATMENT OF ACUTE BRONCHOSPASM ASSOCIATED WITH ASTHMA OR ASTHMATIC BRONCHITIS IN AN EMERGENCY DEPARTMENT.