Transnasal Aerosol Delivery to Pediatric Patients: Jet Versus Vibrating Mesh--Reply.

To the Editor: In the recent paper by El Taoum and associates,1 an in vitro comparison of aerosol dose delivery using jet and vibrating mesh nebulizers with a variety of nasal interface devices in pediatric patient models was presented. The results of this study demonstrated that the jet nebulizer was more efficient than the vibrating mesh nebulizer across all of the nasal interface devices tested. In the conclusion, the authors stated that “Careful pairing of the aerosol generator and interface is very important during transnasal aerosol delivery.” This inarguable fact, however, was not evident in the design or results of this otherwise admirable study. The vibrating mesh nebulizer system used in the study is engineered, recommended, and licensed for use via a mouthpiece or aerosol mask patient interface, not by the nasal route, in pediatric patients. Practical use of any vibrating mesh technology in this setting would require a supplemental flow of gas to drive the aerosol particles toward the patient interface and therefore made available for inhalation. The failure to use a supplemental gas flow with the vibrating mesh nebulizer places the performance of the vibrating mesh technology at an inherent disadvantage compared with a jet nebulizer. In my personal correspondence with one of the authors, it was implied that the intent of this study was to demonstrate which nasal interface devices might be more efficient in the home care setting for pediatric patients. In this context, it can be appreciated and understood that the study results imply that jet nebulization might be the preferred method for certain pediatric patients. However, readers of the Journal may not appreciate the unstated study intent and design limitations and may come away with the wrong message regarding the use of vibrating mesh nebulization in this patient population. Careful pairing of the aerosol generator, patient interface, and the target patient is extremely important during any evaluation of aerosol delivery, a fact that was overlooked in the design of this study and the publication of its results.