The Science Journal of the American Association for Respiratory Care
Background: Our pediatric institution treats over 3,000 asthma exacerbations each year. The National Institute of Health's guidelines for the treatment of status asthmaticus include the use of continuous nebulized beta agonists. Approximately 760 patients were treated with continuous albuterol sulfate each year. Currently the HeartTM nebulizer, in tandem with a blended high flow aerosol delivery system, is used to insure medication administration with adequate inspiratory flow rate and adjustable FiO2. We assessed the Misty Ox GIN BabyTM while searching for an alternative cost-effective system that would similarly deliver adequate flows with adjustable FiO2.
Methods: Since hourly output is strongly influenced by nebulizer volume fill and flow rate, we set up the GIN BabyTM system with a volume of 120cc, nebulizing at the total flow rate of 25 lpm. The solution was nebulized for a duration of one, two, and four hours to evaluate the total output in cc/hr. Combinations of jet and injected flow were used to achieve desired FiO2 with this system. For this reason, we evaluated all combinations of flow rates to achieve total flow rate of 25 lpm. This flow rate delivers adequate inspiratory flows at the widest range of FiO2 to meet most patient demands. At the conclusion of each set time, the remaining solution was measured with a calibrated syringe, and the output was determined. The final hourly output values were averaged to obtain the total output in cc/hr. Experience: Nebulized output of the solution at a standard total flow rate, over four hours, generated a reproducible average output of 30cc/hr.
|System||Jet Flow (lpm)||Injected Flow (lpm)||Total Nebulizer Flow (lpm)||Average Nebulizer Output (cc/hr)||Estimated Annual Disposable Set-up Cost|
Conclusion: Continuous aerosolized albuterol sulfate may be administered through the Misty Ox GIN BabyTM with comparable output to the HeartTM nebulizer with a higher flow rate to meet patients' demand. Additionally, this method provides a cost savings of $36.88 per set up, with an estimated annual saving of $28,102.56. These findings justify a hospital wide evaluation of this product including a potential time savings analysis.