Objective: To assess in vitro nebulized drug delivery during invasive and non-invasive ventilation models, comparing jet and vibrating mesh nebulizers. Aimed to compare differences in absolute inhaled dose, delivery rate and residual volume in various pediatric ventilation models with either face mask, mechanically ventilated, high flow nasal therapy or blow-by methods utilizing approved nebulizer locations. Methods: Compared drug delivery performance of a continuous output jet nebulizer (JN) with a vibrating mesh. The non-invasive model simulated a spontaneously breathing 9-month-old child using an anatomically correct model of upper airways and breathing simulator. The intubated model consisting of a mechanical ventilator with a heated humidifier in a pediatric breathing circuit and endotracheal tube. A JN (Aquineb), driven with 6 L·min -1 or a VMN (Aerogen Solo) driven with 2 L·min -1 supplemental oxygen were assessed by dose, delivery rate and residual volume. Drug dose was quantified using spectrophotometric analysis. Results: During normal spontaneous breathing, VMN dose was almost double that of JN ( P < 0.001), while delivery rate by VMN was also quicker, ( P < 0.001). Residual volume was significantly higher using JN ( P < 0.0001). During mechanical ventilation, VMN had a greater than 3-fold dose ( P < 0.0001), while the rate of delivery by VMN was also quicker ( P < 0.0001). Residual volume was also significantly greater using JN ( P < 0.001) during ventilation. During HFNT, aerosol delivery via nasal cannula was shown to be affected by gas flow rate for both VMN and JN, with again VMN delivering a greater dose over JN . Salbutamol delivery was also significantly greater using VMN for blow-by delivery. Conclusion: This study demonstrates significantly increased dose and rate of delivery, and significantly decreased residual volumes post-nebulization for airway deposition using a VMN compared to JN. Use of VMNs could improve drug delivery in pediatric populations, potentially altering the clinical course.

Background & Objectives: Supplemental oxygen and aerosol therapy may be used in combination as a treatment for neonates suffering from hypoxemia caused by respiratory diseases. Due to cost and lack of availability of oxygen cylinders in some countries, oxygen concentrators are a reported substitute. This study was designed to determine whether using an oxygen concentrator and low-flow oxygen therapy impacts aerosol drug delivery in a simulated spontaneously breathing neonate patient. Methods: A vibrating mesh nebuliser (VMN; Aerogen Solo) was used to aerosolise a 500µL 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 LPM and low-flow oxygen therapy at gas flow rates of 1.0, 4.0 and 5.0 LPM. The mass of drug in terms of emitted and tracheal doses were recorded. The impact of 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. The largest tracheal dose (%) was generated with the oxygen concentrator, 11.01 ± 0.29% at 5.0LPM compared to 9.66 ± 1.53% for low-flow oxygen therapy, p = 0.073. Refill and operation of the VMN did not impact the circuit pressure in either system. Conclusions: This study shows that the system used to provide combinational aerosol and supplemental oxygen therapy has a significant impact on the quantity of nebulised therapeutic delivered to the patient.