• H William Kelly, Kerry A Keim, and Bennie C McWilliams.
• Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM 87131-5311, USA. hwkelly@unm.edu
• Ann Pharmacother. 2003 Jan 1;37(1):23-6.

ObjectiveTo compare the relative delivery of 2 methods for providing continuously nebulized albuterol (CNA): a small-volume nebulizer plus infusion pump versus a large-volume nebulizer.DesignAn open, randomized comparison of 3 hours of CNA administration using an in vitro lung model with a follow-up particle size assessment of the large-volume nebulizer.MethodsSix different nebulizers of each type were connected to a lung model via a volume-limited mechanical ventilator and infant ventilator circuitry. Albuterol was nebulized at 10 mg/h for 3 hours in random order. The small-volume nebulizer used was the Airlife Misty Neb (Baxter, Valencia, CA); the large-volume nebulizer was the HEART Nebulizer (Vortran Medical, Orangevale, CA). One large-volume nebulizer was operated over 8 hours for the output and particle sizing study.ResultsThe small-volume nebulizer delivered a greater amount of albuterol (mean +/- SD percentage of total nebulized) to the model lung (5.75 +/- 1.38% vs. 4.12 +/- 0.67%; p < 0.025) than the large-volume nebulizer, but demonstrated greater variability. Although total output was not maintained after 8 hours of nebulization with the large-volume nebulizer, the percent of particles in the respirable range remained consistent.ConclusionsThe large-volume nebulizer evaluated in this study maintains consistent output up to 8 hours and provides an acceptable method for delivering CNA through an infant ventilator circuit.

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