135 Aerosol Dose Matters in the Emergency Department: A Comparison of the Impact of Bronchodilator Administration With Two Nebulizer Systems

Abstract

Study Objectives: Clinical outcome studies comparing aerosol devices in patients in respiratory distress in the emergency department (ED) are limited. The vibrating mesh nebulizer (VMN) with adapter (Aerogen Ultra, Aerogen Ltd., Ireland) provides> 4-fold drug delivery to lungs compared to jet nebulizer (JN). Aim of the study was to determine whether the improved lung delivery of bronchodilators would have an effect on admission rates, ED discharge rates and total albuterol dose in patients receiving aerosol treatments in the ED.Methods: A retrospective chart review was done comparing all ED patients receiving aerosol bronchodilator treatments with the standard of practice JN (September 2015) to an equivalent period after implementation of the VMN with adapter (October 2015). Logistic regression with controls for age and diagnosis was used to predict effect the device would have on discharge from the ED and disposition.Results: Patient charts were reviewed from September (854 JN) and October (722 VMN). In October, the treated population experienced a reduction in admissions from the ED of 33%, associated with a 29% increase in discharges to home compared to September. Patients receiving bronchodilators with the VMN with adapter were 1.5 times more likely to be discharged than the JN group (OR¼1.5, p < .001), respectively). The JN group was 1.7 times more likely to be admitted than the VMN group (OR¼1.77, p < .001). The VMN group used less total drug (p < .05) with a 75% reduction of maximum albuterol dose administered (20 mg to 5 mg).Conclusions: The VMN with adapter was associated with fewer admissions to the hospital from the ED with a substantial reduction in maximum albuterol dose required than the JN. The device type was a strong predictor of discharge, disposition and total amount of drug, regardless of age or diagnosis. Randomized controlled studies are needed to corroborate these findings.

Effect of a Nebulizer Holding Chamber on Aerosol Delivery

“…Suggesting that the aerosol emitted determines the whole amount delivered to the patient but not the fraction deposited into the lungs. 5,27,28 The holding chamber would deliver more medication to the patient, as presented here by the significant increase of the aerosol emitted, amount of drug excreted in the first 30 min, and amount of drug excreted over a 24-h period after inhalation. These increases would be accompanied by a reduction of the aerosol lost to the atmosphere that may be inhaled by the health-care provider in the vicinity of the patient.…”