Efficacy of a prototype inspiratory‐synchronized small particle versus conventional vibrating mesh nebulizer during pediatric and neonatal mechanical ventilation

Abstract

BackgroundAn inspiration‐synchronized vibrating mesh nebulizer (VMN) has been reported to improve aerosol delivery during adult mechanical ventilation. A prototype VMN generating smaller particles was developed. We aimed to compare the aerosol delivery efficiency of small‐particle and conventional VMNs in inspiration‐synchronized and continuous modes during neonatal and pediatric mechanical ventilation.MethodsA critical care ventilator with heated humidified circuits connected to an endotracheal tube (ETT) and passive test lung was set to pediatric and neonate parameters. Albuterol (2.5 mg/ml, 1 ml) was administered using both small‐particle and conventional VMNs in inspiration‐synchronization and continuous modes. For the pediatric model, VMN was placed at the humidifier inlet, inspiratory limb at Y‐piece, and between Y‐piece and ETT (Y‐ETT). For the neonatal model, VMN was placed at the humidifier inlet and between Y‐ETT. Each setup was repeated five times. Albuterol collected on the filter distal to the ETT was eluted and assayed with UV spectrophotometry (276 nm).ResultsThe inspiration‐synchronized VMN generated higher inhaled doses compared to continuous VMN across all nebulizer placements, particle sizes, and aerosol generation models (all p < .05). The highest inhaled doses (42.2 ± 2.0% and 40.7 ± 1.0% for pediatric and neonate, respectively) were observed with the small‐particle inspiration‐synchronized VMN placed at Y‐ETT. In the pediatric model, the inhaled dose with inspiration‐synchronized conventional VMN was similar, independent of nebulizer placements (24.4 ~ 27.0%). In contrast, the inhaled dose was greatest with continuous VMN placed at the humidifier inlet. With the neonatal model, VMN placed at Y‐ETT yielded higher doses than the humidifier inlet, and small‐particle VMNs outperformed conventional VMNs across all settings (all p < .05).ConclusionThe prototype small‐particle VMN positioned between Y‐piece and ETT in an inspiration‐synchronized mode optimized aerosol delivery during mechanical ventilation in both pediatric and neonatal models.