The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

EFFICACY AND EFFICIENCY OF VIBRATING APERTURE NEBULIZER DEVICE AS COMPARED WITH TRADITIONAL SMALL VOLUME NEBULIZER DEVICES IN AN EMERGENCY DEPARTMENT SETTING

Authors:  Lisa Cracchiolo, AAS, RRT, Cheryl Hoerr, MBA, RRT, CPFT, Donna Clayton BS, RRT: Barnes-Jewish Hospital St. Louis, MO; Marin Kollef, M.D., Robert Poirier, M.D., Washington University School of Medicine, St. Louis, MO.

Background: Traditional small volume jet nebulizer devices are inefficient, deliver a wide range of particle sizes and have prolonged dosing times. In vitro studies of new aerosol generator technology demonstrate that superior performance can be obtained as compared to the traditional small volume jet nebulizers currently in use. If these findings hold true for in vivo performance we will be able to realize more efficient and effective treatment for our respiratory patients while optimizing delivery of aerosolized medications in the Emergency Department (ED).

Method: This is a randomized clinical trial of patients who seek treatment for breathing problems in the ED. Patients are stratified into either an Asthma Group or COPD Group, dependent upon the physician's diagnosis. Patients in each group are randomized to receive either traditional small volume jet nebulizer, or the vibrating aperture nebulizer. The sample size goal is 270 patients per treatment group; study is ongoing.

Results:  Outcomes measured include efficacy, resource utilization and clinical response to therapy. Efficacy is measured through use of bed-side spirometry as measured by FEV1 and peak flow.  We utilize a visual analog scale to quantify subjective dyspnea levels.  Resource utilization is measured by tracking the time necessary to actually administer the therapy.  Additional clinical response variables are analyzed to determine if their occurrence varies directly with type of nebulizer used. These response variables include:  time patient spends in the ED, need for further nebulizer treatments, total number of treatments needed, need for hospital admission and need for intubation and/or non-invasive ventilation.

  Tx 1   Tx 2
  Admin Time Borg Scale Diff PEF Diff VC Diff FEV1 Diff   Admin Time Borg Scale Diff PEF Diff VC Diff FEV1 Diff
Device 1 (VA)Vibrating Aperature (n=43) 8 2 11.5% 16.9% 12.0%   8 0 7.9% 6.5% 6.2%
Device 2Jet nebulizer (n=33) 10 1 20.7% 14.9% 17.6%   10.5 1 6.0% 2.9% 8.5%

Conclusion: We demonstrated that the vibrating aperture nebulizer performed similar to the traditional jet nebulizer using similar volumes of administered solution. Additionally we demonstrated that there is no difference in other clinical response variables related to type of nebulizer used.  Further studies are needed to determine if smaller concentrated volumes of bronchodilator solution can be administered with the vibrating aperture nebulizer in order to reduce the time required for treatment administration.

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