Department of Emergency Medicine, St. John Hospital and Medical Center, United States; Wayne State University, School of Medicine, Detroit, MI 48236, United States.
Respiratory Care, St. John Hospital and Medical Center, Detroit, MI 48236, United States.
Am J Emerg Med. 2018 Apr;36(4):641-646. doi: 10.1016/j.ajem.2017.10.067. Epub 2017 Oct 31.
Projects comparing bronchodilator response by aerosol devices in the ED are limited. Evidence suggests that the vibrating mesh nebulizer (VMN) provides 5-fold greater aerosol delivery to the lung as compared to a jet nebulizer (JN). The aim of this project was to evaluate a new nebulizer deployed in an Emergency Department.
A quality improvement evaluation using a prospectively identified data set from the electronic medical record comparing all ED patients receiving aerosolized bronchodilators with the JN during September 2015 to those receiving aerosolized bronchodilators with the VMN during October 2015.
1594 records were extracted, 879 patients received bronchodilators via JN and 715 patients via the VMN. Admission rates in the VMN group were 28.1% and in the JN group at 41.4%. The total albuterol dose administered was significantly lower in the VMN group compared to the JN (p<0.001). No patient in the VMN group required >5mg albuterol to control symptoms (85% of the VMN group received only 2.5mg) whereas dosing in the JN group was higher in some patients (with 47% receiving only 2.5mg). The use of VMN was also associated with a 13% (37min) reduction in median length of stay in the ED.
The VMN was associated with fewer admissions to the hospital, shorter length of stay in the ED and a reduction in albuterol dose. The device type was a predictor of discharge, disposition and amount of drug used. Randomized controlled studies are needed to corroborate these findings.
在急诊环境中比较支气管扩张剂通过各种雾化器设备产生的效果的研究项目有限。有证据表明，与射流雾化器（JN）相比，振动网孔雾化器（VMN）能将 5 倍剂量的药物输送到肺部。本项目旨在评估一种新的雾化器在急诊科的应用。
这是一项质量改进评估，使用电子病历中前瞻性确定的数据集，比较 2015 年 9 月所有使用 JN 接受雾化支气管扩张剂治疗的急诊患者和 2015 年 10 月使用 VMN 接受雾化支气管扩张剂治疗的患者。
共提取了 1594 份记录，879 例患者通过 JN 接受支气管扩张剂治疗，715 例患者通过 VMN 接受支气管扩张剂治疗。VMN 组的入院率为 28.1%，JN 组为 41.4%。VMN 组的总沙丁胺醇剂量明显低于 JN 组（p<0.001）。VMN 组没有患者需要>5mg 沙丁胺醇来控制症状（85%的 VMN 组仅接受 2.5mg），而 JN 组的一些患者剂量更高（仅 47%接受 2.5mg）。VMN 的使用还与 ED 中位住院时间缩短 13%（37min）相关。
VMN 与更少的住院、ED 住院时间缩短以及沙丁胺醇剂量减少相关。设备类型是出院、处置和药物使用量的预测因素。需要进行随机对照研究来证实这些发现。
