Vibrating Mesh and Jet Nebulizer Performance in Pediatric Respiratory Support: A Multi-Modality In Vitro Comparison

Background: The aim of this study was to assess in vitro nebulized drug delivery during invasive and non-invasive ventilation, comparing jet nebulizers (JN) and vibrating mesh nebulizers (VMN) across various pediatric ventilation models. Methods: Drug delivery performance was compared between a continuous output JN (Aquineb) and VMN (Aerogen Solo A-VMN). The non-invasive model simulated a spontaneously breathing 9-month-old child using an anatomically correct upper airway model and breathing simulator. The invasive model used a mechanical ventilator with heated humidifier in a pediatric breathing circuit with an endotracheal tube. Nebulizers were driven with supplemental oxygen at manufacturer-recommended rates and positioned at approved locations. Absolute inhaled dose, delivery rate and residual volume were assessed using face mask, mechanical ventilation, high-flow nasal therapy and blow-by delivery methods. Dose was quantified using spectrophotometric analysis. Results: During spontaneous breathing, A-VMN delivered almost double the dose of the evaluated JN (p < 0.001), with a significantly faster delivery rate (p < 0.001) and lower residual volume (p < 0.0001). During mechanical ventilation, A-VMN demonstrated a greater than 3-fold increase in delivered dose (p < 0.0001) and faster delivery (p < 0.0001), with reduced residual volume (p < 0.001). During high-flow nasal therapy, delivery via nasal cannula was affected by gas flow rate for both devices, with A-VMN consistently delivering greater doses. A-VMN delivered significantly greater salbutamol doses during blow-by delivery. Conclusions: VMN demonstrated significantly superior dose delivery, faster delivery rates and reduced residual volumes compared to the evaluated JN across all tested pediatric respiratory support modalities. These in vitro findings provide important performance data for evidence-based device selection and warrant clinical investigation to determine potential therapeutic benefits in pediatric populations requiring aerosol therapy during respiratory support.