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

Abstract

BACKGROUND AND IMPORTANCE: 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. OBJECTIVE: 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. DESIGN, SETTINGS AND PARTICIPANTS: 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 (?VT) from baseline. MAIN RESULTS: 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. ?VT mirrored these findings. No significant correlation was observed between VT and pressure support levels. CONCLUSION: 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.