Comparison of bronchodilator administration with vibrating mesh nebulizer and standard jet nebulizer in the emergency department

Introduction: Projects comparing bronchodilator response by aerosol devices in the ED are limited. Evidence suggests that the vibrating mesh nebulizer (VMN) provides 5-fold greater aerosol delivery to the lung as compared to a jet nebulizer (JN). The aim of this project was to evaluate a new nebulizer deployed in an Emergency Department. Methods: A quality improvement evaluation using a prospectively identified data set from the electronic medical record comparing all ED patients receiving aerosolized bronchodilators with the JN during September 2015 to those receiving aerosolized bronchodilators with the VMN during October 2015. Results: 1594 records were extracted, 879 patients received bronchodilators via JN and 715 patients via the VMN. Admission rates in the VMN group were 28.1% and in the JN group at 41.4%. The total albuterol dose administered was significantly lower in the VMN group compared to the JN (p < 0.001). No patient in the VMN group required >5 mg albuterol to control symptoms (85% of the VMN group received only 2.5 mg) whereas dosing in the JN group was higher in some patients (with 47% receiving only 2.5 mg). The use of VMN was also associated with a 13% (37 min) reduction in median length of stay in the ED. Conclusions: The VMN was associated with fewer admissions to the hospital, shorter length of stay in the ED and a reduction in albuterol dose. The device type was a predictor of discharge, disposition and amount of drug used. Randomized controlled studies are needed to corroborate these findings. (C) 2017 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license.