091 - Circulaire nebulizer compared to continuous large volume nebulizer of albuterol treatments in the management of acute asthma exacerbations in the Pediatric Emergency Department

Publication Number: 91.4107

Hannah Starke, Phoenix Children's Hospital, Tempe, AZ, United States; Cherisse Mecham, Phoenix Children's Hospital, Phoenix, AZ, United States; Saul R. Favila, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, United States; Hamy Temkit, Phoenix Children's Hospital, Phoenix, AZ, United States; Nisha S. Issac, Phoenix Children's Hospital, Phoenix, AZ, United States

Background: Asthma exacerbations are one of the most common reasons for presentation to the Emergency Department (ED) and hospitalizations for the pediatric population in the United States. Traditional large volume nebulizer (LVN) treatments have been used to administer albuterol for treatment of acute asthma exacerbations using an open circuit to create aerosolized albuterol which is then inhaled via a mouthpiece or oxygen mask.
In 2003, the first Circulaire nebulizer (C-Neb) apparatus was introduced. The device consists of a one-way valve with a reservoir bag that holds the aerosol inside the bag until the patient actively inhales. Given its closed-circuit system, our free-standing children’s hospital transitioned to this device in June 2020 to protect staff during the COVID-19 pandemic. It was theorized that it was as effective as the traditional nebulizer, but no study has compared patient outcome measures between the two devices.

Objective: This study aims to compare patient outcomes, including total albuterol usage and ED length of stay (LOS), for pediatric patients presenting to the ED in acute asthma exacerbation between January 2019 and July 2022.

Design/Methods: This is an IRB approved, retrospective chart review using ICD-10 codes for asthma and wheezing for patients aged 2 to 18 years between January 2019 to July 2022, with LVN transitioning to C-Neb in June 2020. Data were summarized using frequencies and percentages for categorical variables and using mean and standard deviation for continuous measures. The Wilcoxon Rank Sum Test was used to compare the outcomes between LVN and C-Neb.

Results: A total of 2,777 patients met inclusion criteria for this study, with 2061 (74%) patients receiving LVN and 716 (25.8%) patients receiving C-Neb. The total dosage of nebulized albuterol was significantly lower for the C-Neb cohort than those who received LVN (25.8 mg vs 30.5mg, p< 0.001). We found no difference in the overall ED LOS between the two treatment modalities, (5.3 hours for LVN vs 5.3 hours for C-Neb, p=0.58).

Conclusion(s): Our study found that patients who received albuterol via C-Neb compared to LVN received on less overall albuterol with no difference in ED LOS, making it an effective modality for treating acute asthma exacerbations within the ED. Reduced albuterol dosages can reduce the incidence of adverse effects in patients including tachycardia, palpitations, and anxiety. Additionally, the closed circuitry of the C-Neb can significantly reduce the aerosolization and dispersion of droplets, thus improving infection control in the ED for patients and healthcare workers