Vibrating mesh nebulization increases tidal volume relative to jet nebulization during NIV in COPD exacerbation.

Abstract

<h4>Background and importance</h4>Noninvasive ventilation (NIV) is the first-line treatment for acute exacerbations of chronic obstructive pulmonary disease (COPD) with hypercapnic respiratory failure (HRF). Bronchodilator therapy is essential during NIV, but real-world clinical comparisons of nebulization devices in this acute setting remain limited.<h4>Objective</h4>To compare the clinical efficacy of vibrating mesh nebulizers (VMN) versus jet nebulizers (JN) in COPD patients undergoing NIV, using changes in tidal volume (VT) as the primary outcome.<h4>Design, settings and participants</h4>A longitudinal observational study was performed in the ventilatory unit of the emergency department of a tertiary hospital. Patients requiring NIV for HRF were allocated to two cohorts: VMN (October 2023-March 2024) and JN (January 2015-May 2017). Ventilatory parameters, including VT, were recorded at baseline, 15 minutes, 1 hour, and 3 hours. The primary outcome was the percentage change in VT (ΔVT) from baseline.<h4>Main results</h4>Eighty-four patients were analyzed (VMN: n=41; JN: n=43). Baseline characteristics were comparable between groups. The VMN cohort exhibited a significantly greater increase in VT at 1 hour and 3 hours (p<0.05) compared with the JN cohort. ΔVT mirrored these findings. No significant correlation was observed between VT and pressure support levels.<h4>Conclusion</h4>In this real-world ED study of COPD patients treated with continuous NIV, VMN was associated with a greater early increase in VT than JN, consistent with more effective bronchodilator delivery. Given the historical, non-randomized design across different time periods and ventilators, and the use of VT as an indirect endpoint, these findings should be interpreted as hypothesis-generating but provide a clinically relevant starting point supporting preferential VMN use in acute practice.