Question

A 2-year-old female with spinal muscular atrophy type 1 presented to the emergency department in moderate respiratory distress. Physical assessment showed a bell-shaped configuration of thorax and ribs, and moderate intercostal and substernal retractions. The patient was receiving bilevel positive airway pressure (BiPAP) at home with the following settings: spontaneous mode, pressure 18/10 cm H2O, room air, with 4-hour sprints twice a day. BiPAP was initiated on the following settings: spontaneous/timed mode rate of 22, pressure 20/10 cm H2O, and FIO2 0.40. Albuterol and hypertonic saline were administered by jet nebulizer and an aggressive secretion clearance regimen was ordered. Chest radiograph revealed diffuse left lung opacification consistent with left lower lobe pneumonia, clear visualization of the diaphragm, and left upper lobe atelectasis. The right lung was clear. The patient was transferred to the pediatric intensive care unit (PICU). Due to increased work of breathing, the patient settings were increased to BiPAP 24/12 × 28 60% FiO2 around the clock for impending respiratory failure. Albuterol treatments were increased to Q2 hours followed by chest percussion, postural drainage, and cough assist. The patient’s respiratory status continues to deteriorate. She was intubated and mechanical ventilation initiated. A vibrating mesh nebu- lizer was used to deliver medicated aerosol therapy inline with the ventilator circuit.

1. Why was the vibrating mesh nebulizer selected when the patient was intubated and switched from a noninvasive ventilator to an ICU ventilator?

Answer 1

The vibrating mesh nebulizer was used when the patient was intubated and switched from noninvasive to icu ventilator,because:

• Comparing with a jet nebulizer ,a nebulizer that utilizes vibrating mesh technology can create a much smaller, consistent particle size that is inhaled, making drug delivery easier and more effective.
• By vibrating at a high rate for a short distance, the many laser drilled holes of the vibrating mesh act like a pump drawing medication through them and creating an incredibly small particulate mist that is easily inhaled into the lungs to rapidly facilitate relief.
• benefits include:

Silent operation making it easy to take treatment anywhere

Consistent, small particle size

Increased efficacy of treatment for faster therapy times

Portable, so no reason for missed treatments

• aerosols produced by vibrating mesh nebulizers have a higher respirable fraction, the nominal dose of drugs to be administered for clinical response could be reduced compared to jet or ultrasonic nebulizers.
• vibrating mesh nebulizers neither cool nor heat the solution, there is minimal risk of denaturation, and they are thus recommended for use with complex microstructures and large molecules.

The goals of nebulization  therapy during mechanical ventilation could be best achieved by (1) assuring drug delivery; (2) optimizing drug deposition in the lung; (3) providing consistent dosing; (4) avoiding inappropriate therapies; (5) achieving reproducible dosing; (6) employing clinically feasible methods; (7) enhancing the safety of inhaled drugs; and (8) controlling costs of aerosol therapy