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PULMONARY

Comparison of Two Methods of Delivering Continuously Nebulized Albuterol

Professor Emeritus of Pharmacy and Pediatrics, Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM

Kerry A Keim, PharmD

Pharmacist, Covenant Medical Center, Lubbock, TX

Bennie C McWilliams, MD

Associate Professor of Pediatrics, Department of Pediatrics, University of New Mexico Health Sciences Center

Reprints: H William Kelly PharmD BCPS, Department of Pediatrics, ACC Building 3rd Floor, University of New Mexico Health Sciences Center, 2211 Lomas Blvd. NE, Albuquerque, NM 87131-5311, Fax 505/272-6749, E-mail hwkelly{at}unm.edu

OBJECTIVE: To compare the relative delivery of 2 methods for providing continuously nebulized albuterol (CNA): a small-volume nebulizer plus infusion pump versus a large-volume nebulizer.

DESIGN: An open, randomized comparison of 3 hours of CNA administration using an in vitro lung model with a follow-up particle size assessment of the large-volume nebulizer.

METHODS: Six different nebulizers of each type were connected to a lung model via a volume-limited mechanical ventilator and infant ventilator circuitry. Albuterol was nebulized at 10 mg/h for 3 hours in random order. The small-volume nebulizer used was the Airlife Misty Neb (Baxter, Valencia, CA); the large-volume nebulizer was the HEART Nebulizer (Vortran Medical, Orangevale, CA). One large-volume nebulizer was operated over 8 hours for the output and particle sizing study.

RESULTS: The small-volume nebulizer delivered a greater amount of albuterol (mean ± SD percentage of total nebulized) to the model lung (5.75 ± 1.38% vs. 4.12 ± 0.67%; p < 0.025) than the large-volume nebulizer, but demonstrated greater variability. Although total output was not maintained after 8 hours of nebulization with the large-volume nebulizer, the percent of particles in the respirable range remained consistent.

CONCLUSIONS: The large-volume nebulizer evaluated in this study maintains consistent output up to 8 hours and provides an acceptable method for delivering CNA through an infant ventilator circuit.

Key Words: albuterol, continuous nebulization

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