The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

OUTPUT PERFORMANCE OF 2 BRANDS OF LARGE VOLUME CONTINUOUS NEBULIZERS (LVN)

Dave N. Crotwell, Jim Weatherbee, John Salyer; Respiratory Care, Seattle Children’s Hospital, Seattle, WA

Background: Anecdotal reports from clinicians led us to speculate that there was significant variability in the aerosol output of the LVN we were using for the delivery of Albuterol Sulfate in our emergency department and our inpatient units. We currently use the Misty Finity® LVN from Airlife for all our continuous nebulization. This led us to an evaluation of two brands of LVN. Methods: Testing of the two brands (Misty Finity® from Airlife, and Flo-Mist™from Smiths Medical)of LVN was done using a single oxygen flow meter and oxygen outlet in the laboratory area of our department. We tested 3 LVN of each brand from the same product lots. We filled the each LVN with 0.9% normal saline to a volume for 4 hours of nebulization, based on the manufacturers specified hourly output. Manufacturers specifications were as such; Misty Finity® 30 mL/hr of output at 11 L/m of flow and Flo-Mist™ 25 mL/hr at 13 L/m of flow. Each LVN was run at the manufacturers specified flow rate and the hourly nebulized volume was determined by measuring the volume left at the end of each hour of nebulization and subtracting that from the total volume the LVN was originally filled with. This was repeated for all four hours and the residual volume was documented at the end of the four hour period. Results: Results are displayed in the table below. Conclusion: The testing showed that there was great variability in the aerosol output of both brands of LVN. This confirmed the reports from our staff that the Misty Finity® LVN had a large amount of residual volume at the end of the nebulization period. Even though both nebulizers had a large amount of variation in nebulization, we chose to switch from the Misty Finity® LVN to the Flo-Mist™ LVN after this evaluation. We did this because the Flo-Mist™ LVN did not have residual volume at the end of the nebulization period, which we feel would increase the chance of medication delivery. We speculate that all disposable continuous nebulizers have highly variable aerosol output. Inconsistent drug delivery may have important implications for acutely ill patients in whom timely administration of bronchodilators is essential. We further speculate that the characteristics of the aerosols produced by these devices might also be highly variable and thus potentially inefficient. Further study of the aerosol characteristics of these devices needs to be done. Sponsored Research - None

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