Testing of Nebulizers for Delivering Magnesium Sulfate to Pediatric Asthma Patients in the Emergency Department

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BACKGROUND: As the use of intravenous magnesium sulfate (MgSO4) for the treatment of refractory asthma is becoming more common, the incidence of MgSO4-related systemic hypotension is also rising. One option is to deliver MgSO4 via aerosol, but compared to most inhaled medications, which are active in the microgram dose range, the MgSO4 dose requirement is in the milligram range. This, along with inefficient aerosol delivery systems, may be the reason that some studies have found lack of efficacy with aerosol MgSO4. In preparation for a multicenter study of inhaled MgSO4 in asthmatic children 2‐17 years old, we conducted an in vitro study to choose the best MgSO4 nebulizer system that would be effective over the entire age range. METHODS: We tested the Pari LC Star jet nebulizer, Omron MicroAir vibrating-mesh nebulizer, and the Aeroneb Go vibrating-mesh nebulizer with the Idehaler valve-less holding chamber. Aerosol delivery was via face mask. RESULTS: The Pari LC Star had an appropriate particle size distribution but a very slow aerosol output rate. The Omron MicroAir had an even slower output rate and a larger particle size distribution, which would be inappropriate for smaller children. In vitro lung deposition with the Aeroneb Go with Idehaler was 16.0 ± 0.4 mg/min in older children and approximately a fifth of that in toddlers. CONCLUSIONS: The Aeroneb Go with Idehaler was chosen for the multicenter clinical study.

Keywords: aerosol delivery; asthma; magnesium sulfate; nebulizer; pulmonary deposition

Document Type: Research Article

DOI: http://dx.doi.org/10.4187/respcare.00826

Affiliations: Department of Physiology and Experimental Medicine; University of Toronto, Toronto, Ontario, Canada.

Publication date: March 1, 2011

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