Delivery of Continuous Albuterol During Emergency Medical Services Transport

Background: Continuous nebulization is commonly used to treat asthma exacerbations and can be administered with different delivery devices such as a large volume nebulizer (LVN) or vibrating mesh nebulizer (VMN). The VMN can be used to deliver continuous albuterol in conjunction with high-flow nasal cannula (HFNC) and noninvasive ventilation, whereas the LVN requires a mask or mouthpiece. In 2021, our specialized, pediatric interfacility transport team changed from LVN to VMN to deliver continuous albuterol during medical transport. The aim of this study was to compare outcomes for children treated with continuous albuterol via LVN or VMN during air and ground interfacility transport. Methods: A retrospective review was completed for children with asthma who were admitted to the hospital and treated with continuous albuterol during transport from 6/1/2018 to 6/30/2023. The primary outcomes were hospital length of stay and total duration of continuous albuterol (transport + admission). Descriptive statistics were used to summarize results. Mann-Whitney test was used to compare continuous outcomes and Chi-square statistics were used to compare nominal variables. P < .05 was considered statistically significant. Results: 98 children met inclusion criteria with 52 and 46 in the LVN and VMN groups, respectively. Median (IQR) age was 6 (3-9) y, and the majority were male (56, 57%). The LVN group had more non-Hispanics (P = .02). No differences were found between groups with regard to sex, race, asthma classification, transport type, admission unit (PICU vs. intermediate care unit), initial albuterol dose during transport or admission, transport time, or PRISM 3 score. The VMN used more HFNC during transport (P < .001). Total duration of continuous albuterol and hospital length of stay were similar for each group. Conclusions: Total duration of continuous albuterol and hospital length of stay were not affected by the choice of nebulizer system used during pediatric interfacility transport.