Vibrating Mesh Nebulizer (A-VMN) Performance During Low-Flow Nasal Oxygen Therapy in Neonates

Background: Supplemental oxygen and aerosol therapy may be used simultaneously to treat neonates suffering from hypoxemia caused by respiratory diseases. Due to the cost and lack of availability of oxygen cylinders in some countries, oxygen concentrators are a reported substitute. We assessed whether an oxygen concentrator compared to low-flow oxygen therapy impacts neonatal aerosol drug delivery. Methods: A vibrating mesh nebulizer (A-VMN; Aerogen Solo) was used to aerosolize a 500 µg dose of salbutamol. The aerosol was delivered via a nasal cannula to a neonate head model in combination with oxygen concentrator at gas flow rates of 0.2, 1.0, and 5.0 L per minute (LPM), and low-flow oxygen therapy at gas flow rates of 1.0, 4.0, and 5.0 LPM. Emitted and tracheal doses were recorded. The impact of A-VMN operation and refill on circuit pressure in both systems was also measured. Results: The oxygen concentrator delivered a higher emitted dose than the low-flow system, the largest emitted dose (%) being 20.58 ± 0.50% and 14.69 ± 0.89%, respectively, at 1.0 LPM, p = 0.018. At 5.0 LPM, the tracheal dose was 11.01 ± 0.29% for the oxygen concentrator compared to 9.66 ± 1.53% for low-flow oxygen therapy, p = 0.073. Refill and operation of the A-VMN did not impact the circuit pressure in either system. Conclusions: This study shows that the system used to provide concurrent aerosol and supplemental oxygen therapy has a significant impact on the quantity of nebulized drug delivered to patients.