2007 OPEN FORUM Abstracts
IN-VITRO COMPARISON OF 4 CONTINUOUS NEBULIZERS
R. Willis1, T. Tom Leisenring 1, A. Berlinski1, 2
Background: Continuous albuterol nebulization has become the standard of care for patients on status asthmaticus. We have noticed at our institution a significant variance in the solution output of the large volume nebulizers. Therefore, we decided to investigate the solution and drug output of 4 different brands of large volume continuous nebulizers.
Methods: Six units of the following nebulizer brands were studied: Hope (HO) (B&B Medical Technologies Inc, Loomis, CA), Flo-Mist (FM) (DHD Healthcare, Wampsville, NY), Airlife Misty Finity (AM) (Cardinal Health, McGaw Park, IL), and Heart (HE) (Westmed Inc, Tucson, AZ). All nebulizers were operated with central oxygen at 50 PSI at recommended flows (HE & HO 10 lpm; AM 11 lpm & FM 13 lpm) and connected to 6â flexible corrugated tubing. Sixteen mls of 0.5% albuterol sulfate nebulizer solution were diluted in either 224 mls (AM & HE) or 184 mls (FM & HO) of normal saline solution. Solution output (SO) and reservoir albuterol concentration were determined hourly for 8 hours. SO was determined by gravimetric technique and albuterol concentration was determined by spectrophotometry at 276 nm. Sputtering times were recorded. Target outputs were Â± 20% of manufacturerâs specifications [HO & FM 25 ml/h & AM & HE 30 ml/h for SO, and 10mg/h for drug output (DO) for all]. Analysis was performed utilizing ANOVA with p significance set at p<0.05.
Results: (Mean Â± SD ) SO (ml/hr) was: HE 27.44 Â± 8.92; HO 22.04 Â± 1.62; AM 28.4 Â± 4.18; & FM 27.15 Â± 3.07. Targeted SO were achieved except for: HE at 4th 7th & 8th hour; AM at 8th hour; & FM at 7th & 8th hour. Sputtering occurred before the 8th hour on 66%, 33%, 100% & 100% for HE, HO, AM, & FM respectively. Targeted DO were achieved except for: HE at 1st & 8th hour; HO at 1st-3rd hour, AM at 7th & 8th hour, & FM at 5th 6th & 8th hour.
Conclusions: Continuous nebulizers systems should be monitored closely. Tested brands should not be operated more than 6 hours without replacing the solution. The Hope nebulizer overall had the best performance.