AEROSOL DOSE MATTERS IN THE EMERGENCY DEPARTMENT: A COMPARISON OF IMPACT OF BRONCHODILATOR ADMINISTRATION WITH TWO NEBULIZER SYSTEMS Dunne, R,1 Shortt SA,1 Dailey PA,2 (1. St. John Hospital and Medical Center, Detroit, MI, 2. Aerogen Ltd., Galway, Ireland) ld Introduction Clinical outcome studies comparing aerosol devices in patients in respiratory distress in the Emergency Department (ED) are limited. The vibrating mesh nebulizer (VMN) with adapter (Aerogen Ultra, Aerogen Ltd., Ireland) provides > 4-fold drug delivery to lungs compared to jet nebulizer (JN). Aim of the study was to determine whether the improved lung delivery of bronchodilators would have an effect on admission rates, ED discharge rates and total salbutamol dose in patients receiving aerosol treatments in the ED. Vibrating Mesh Technology Figure 1. Details of the Device Used Results Patient data was extracted from Sept (879 JN) and Oct (715 VMN). In Oct treated population experienced a reduction in admissions from the ED associated with an increase in discharges to home compared to Sept., Patients receiving bronchodilators with the VMN with adapter were 1.5 times more likely to be discharged than the JN group (OR=1.5, p < .001), respectively). The JN group was 1.7 times more likely to be admitted than the VMN group (OR=1.77, p < .001). The VMN group used less total drug (p < .05) with a 75% reduction of salbutamol dose administered (20 mg to 5 mg). Admission rates When compared to the Jet neb group, admission rates are 32% lower with VMN Discharge rates When compared to the Jet neb group, discharges are 30% higher with VMN Length of Stay Reduced by 13% 37 minute median reduction in LOS per patient with the VMN vs. Jet neb Vibrating Mesh Nebulizer Figure 4. Length of Stay Group JN (N=879) VMN (N=715) L2> Methods The Aerogen Ultra was implemented for 30 days during the evaluation period for all patients receiving inhaled bronchodilator therapy. » All age groups were treated. » The time period was prospectively identified. A report was built from available EMR data. » A retrospective data extraction was performed from the CERNER EMR comparing all ED patients receiving aerosol bronchodilator treatments with the standard of practice JN (September 2015) to an equivalent period after implementation of the Aerogen Ultra (October 2015). » A total of 1594 patient encounters were reviewed (879 JN and 715 VMN). 5372 AER PM321 ROW Detroit Poster A3 Salbutamol F.indd 1 Gender (%) Female Male Age (Mean (SD)) Pre Heart Rate (Mean (SD)) Pre Respiratory Rate (Mean (SD)) Post Heart Rate (Mean (SD)) Post Respiratory Rate (Mean (SD)) Table 1. Demographics of the groups Frequencies and Percentages for Patient Disposition by Intervention Group Stratified by Age Group JN (N=879)_ VMN (N=715) Ages 0 to 2 years Admit - ER 7 Ages 3 to 18 years Admit - ER 20 Ages 19 to 50 years Admit - ER 86 Ages 51 or more years Admit - ER 248 Table 2. Frequencies and Percentages by Age « Conclusions The VMN with adapter was associated with fewer admissions to the hospital from the ED with a substantial reduction in salbutamol dose required than the JN. The device type was a strong predictor of discharge, disposition and total amount of drug, regardless of age or diagnosis. Randomized controlled studies are needed to corroborate these findings. St John Hospital and Medical Center, 22101 Moross, Detroit, MI 48236 References 1. Wallet F, Delannoy B, Haquin A, Debord S, Leray V, Bourdin G, et al. Evaluation of recruited lung volume at inspiratory plateau pressure with PEEP using bedside digital chest x-ray in patients with acute lung injury/ARDS. Respir Care 2013;58(3):416-423. 2. Chang SY, Dabbagh O, Gajic O, Patrawalla A, Elie MC, Talmor DS, et al; on behalf of the United States Critical Illness and Injury Trials Group: Lung Injury Prevention Study Investigators (USCIITG-LIPS). Contemporary ventilator management in patients with and at risk of ALI/ARDS. Respir Care 2013;58(4):578-588. 3. Rouby JJ, Arbelot C, Brisson H, Lu Q, Bouhemad B. Measurement of alveolar recruitment at the bedside: the beginning of a new era in respiratory monitoring? (editorial). Respir Care 2013;58(3):539-542. 4. Ng S, King CS, Hang J, Clifford R, Lesho EP, Kuschner RA, et al. Severe cavitary pneumonia caused by a non-equi Rhodococcus species in an immunocompetent patient. Respir Care 2013;58(4):e47-e50. doi:10.4187/respcare.02017 Disclosures: Ms. Dailey is a Medical Science Liaison for Aerogen Ltd. Aerogen Ltd provided the devices for the project.