A Retrospective Observational Study of Vibrating Mesh Nebulizers in the Pediatric Emergency Department

Abstract

Objective: To determine outcomes of bronchodilator delivery with a vibrating mesh nebulizer (VMN) in a pediatric emergency department (ED).

Methods: We performed an in vitro analysis of the VMN and a retrospective observational study of patients receiving nebulized albuterol for a respiratory indication before (April 24, 2022-August 11, 2022) and after (April 24, 2023-July 29, 2023) introduction of the VMN in the ED.

Results: Six hundred five children ages 1 to 17 years were included (302 preintervention, 303 postintervention). The adjusted total albuterol dose per patient was less in the postintervention group (-15.8 mg; 95% CI: -17.5 mg, -14.2 mg). The adjusted time to disposition was less post-intervention (-36 min; 95% CI: -51, -20). The adjusted odds of admission to the hospital or if admitted to the intensive care unit (ICU) were not statistically different [admission adjusted odds ratio (aOR): 1.1; 95% CI: 0.7, 1.7; ICU admission if admitted aOR: 1.7; 95% CI: 0.7, 4.3]. Adjusted mean change in respiratory score with first nebulizer was similar (-0.2; 95% CI: -0.6, 0.3). Within 72 hours of disposition, odds of unplanned transfer to the ICU after admission were similar (aOR: 0.4; 95% CI: 0.1, 1.6), as was unplanned ED return after discharge (aOR: 0.7; 95% CI: 0.3, 1.9).

Conclusions: VMN use in the pediatric ED was associated with a lower total albuterol dose per patient as well as a shorter time to disposition. It did not change the odds of admission, admission to the ICU, unplanned transfers to the ICU after admission, or returns to the ER within 72 hours of discharge.

Keywords: albuterol; asthma; emergency care.