Evaluation of nebulizers for use in neonatal ventilator circuits

The use of nebulizers in neonatal ventilator circuits offers a new and relatively uncharted route of therapy for infants in respiratory failure. We used a model lung to investigate and compare different nebulizer types and therapeutic agents and to make practical observations. Five different nebulizers (Ultravent, Acorn, MAD2, Small Particle Aerosol Generator, and Pulmosonic) were compared for efficiency of delivery of an amino-phylline aerosol to the model lung, and the particle size of aerosol produced by them was measured. A Nebulizer Efficiency Index (NEI) was created, representing the deposition rate of the original solution as aerosol upon the model lung filter. The Acorn (2.8.10(3) ml/min) and MAD2 (2.4.10(-3) scored highest NEI. When a suspension of budesonide was nebulized, minimal amounts of drug were recovered from the filter when the nebulizer producing the smallest particle size (Ultravent) was studied, suggesting that suspensions of drugs behave differently from solutions. Significant changes need to be made to a conventional circuit when jet nebulizers are used; most of these are obviated by the use of an ultrasonic nebulizer, which also avoids the potential problem of marked cooling of the gas flow produced by jet nebulizers.