Vibrating Mesh Nebulizer Compared With Metered-Dose Inhaler in Mechanically Ventilated Subjects

Area of Science:

• Pulmonary Medicine
• Critical Care Medicine
• Medical Device Technology

Background:

• The comparative impact of aerosol delivery devices on patient outcomes during mechanical ventilation remains unclear.
• Ventilator-associated pneumonia (VAP) rates may vary depending on the aerosol delivery method.
• This study investigates VAP occurrence and patient outcomes between vibrating mesh nebulizers and metered-dose inhalers.

Purpose of the Study:

• To determine if vibrating mesh nebulizers (AeroNeb Solo) result in different VAP rates compared to metered-dose inhalers (MDI).
• To compare patient outcomes, including days of ventilation and in-hospital mortality, between the two aerosol delivery devices.

Main Methods:

• Retrospective review of medical records for mechanically ventilated adult patients receiving aerosol treatments.
• Data collected from August 2011 to August 2013, encompassing a hospital conversion from MDI to vibrating mesh nebulizers.
• Exclusion criteria included tracheostomy, ventilation <24 hours, combination treatments, and re-intubation.

Main Results:

• 228 subjects were analyzed; 21% received MDI and 79% received vibrating mesh nebulizer treatments.
• No statistically significant difference in median days of ventilation between MDI and vibrating mesh nebulizer groups.
• No correlation found between device type and VAP or in-hospital mortality; however, increased ventilation days and higher APACHE II scores correlated with increased mortality.

Conclusions:

• No association was found between the use of metered-dose inhalers or vibrating mesh nebulizers and the primary outcomes of VAP, days of ventilation, or in-hospital mortality.
• Longer mechanical ventilation duration was independently associated with increased odds of VAP and mortality.
• Higher APACHE II scores were associated with increased odds of in-hospital mortality.