Performance Comparisons of Jet and Mesh Nebulizers Using Different Interfaces in Simulated Spontaneously Breathing Adults and Children

Background: Different types of nebulizers and interfaces are used for the treatment of adults and children with pulmonary diseases. The purpose of this study was to determine the efficiency of a mesh nebulizer (MN) with a proprietary adapter and a jet nebulizer (JN) under different configurations in adult and pediatric models of spontaneous breathing. We hypothesize that delivery efficiency of JN and MN will differ depending on the interface used during aerosol therapy in simulated spontaneously breathing adult and pediatric models. While we expect that aerosol delivery with JN will be less efficient than MN, we also hypothesize that lung deposition obtained with the adult lung model will be more than that with the pediatric lung model in all conditions tested in this study. Methods: A lung model using a teaching manikin connected to a sinusoidal pump via a collecting filter at the level of the bronchi simulating a spontaneously breathing adult (Vt 500mL, RR 15bpm, I:E ratio 1:2) or pediatric patient (Vt 150mL, RR 25bpm, I:E ratio 1:2). Albuterol sulfate (2.5mg/3mL) was aerosolized with JN (Mistymax 10, Airlife) or MN (Aerogen Solo (R), Aerogen) with the Adapter (Aerogen Solo (R) Adapter, Aerogen Ltd, Galway, Ireland) using mouthpiece, aerosol mask, and valved-mask in adults and the dragon mask, aerosol mask, and valved-mask in pediatrics (n=3). The Adapter, specifically designed for MN, was attached to all the interfaces used in this study with supplemental oxygen of 2lpm, and in addition, the MP was tested with no additional flow in the adult model. The JN was driven with 10lpm based on the manufacturer's label. Drug was eluted from the filter and analyzed via spectrophotometry. Descriptive statistics, dependent t-test and one-way analysis of variance were used for data analysis. Significant level was set at 0.05. Results: In adults, delivery efficiency of JN with the valved mask was significantly greater than that with the aerosol mask (p=0.01). Aerosol delivery of JN with the mouthpiece was not statistically significant from the valved mask (p=0.123) and the aerosol mask (p=0.193). Drug delivery with MN with mouthpiece (15.421.4%) and valved-mask (15.15 +/- 1.1%) was greater than the open aerosol mask (7.54 +/- 0.39%; p=0.0001) in the adult lung model. With no flow mouthpiece delivery increased>2 fold (34.9 +/- 3.1%; p=.0001) compared to use of 2lpm of flow. Using the JN with the pediatric model deposition with valved-mask (5.3 +/- 0.8%), dragon mask (4.7 +/- 0.9%), and aerosol mask (4.1 +/- 0.3%) were similar (p>0.05); while drug delivery with MN via valved-mask (11.1 +/- 0.7%) was greater than the dragon mask (6.44 +/- 0.3%; p=0.002) and aerosol mask (4.6 +/- 0.4%; p=0.002), and the dragon mask was more efficient than the open aerosol mask (p=0.009) Conclusion: The type of nebulizer and interface used for aerosol therapy affects delivery efficiency in these simulated spontaneously breathing adult and pediatric models. Drug delivery was greatest with the valved-mouthpiece and mask with JN and MN, while the standard aerosol mask was least efficient in these simulated spontaneously breathing adult and pediatric lung models. Delivery efficiency of JN was less than MN in all conditions tested in this study except in the aerosol mask. Lung deposition obtained with the adult lung model was more than that with the pediatric lung model.