August 2007

Three Great Ways to Promote Respiratory Care
We’d all like more people to know who respiratory therapists are and what they do. The AARC has three great ways to get the job done, and they’re all heating up right now: we’ve just launched a new web page for National Respiratory Care Week, the ARCF’s Ventilator 5K is seeking participants, and the brand new AARC Life & Breath video is up for preview and purchase in the AARC Store. Check them out and see how you can use these great events and tools to let more people in on the best kept secret in health care today (your profession!). RC WEEK VENTILATOR 5K LIFE & BREATH

Steroids Found Ineffective for Bronchiolitis
Investigators who studied hospitalization rates in 600 infants without a history of wheezing who presented to the emergency department with moderate-to-severe bronchiolitis find treatment with steroids is not effective. The children were divided into two groups: one received a dose of dexamethasone while the other received a placebo. All were evaluated one and four hours later. The hospital admission rate for both groups was nearly 40%, and children recovered at about the same rate regardless of whether they had received the steroid treatment or not. The multicenter study was conducted by the Pediatric Emergency Care Applied Research Network and published in the July 26 issue of the New England Journal of Medicine. READ ARTICLE READ PRESS RELEASE

Jury Still Out on HFOV
A new meta-analysis that compared high frequency oscillatory ventilation (HFOV) with conventional ventilation (CV) in 3585 preterm infants taking part in 15 clinical trials finds little benefit for HFOV but suggests the need for more study to look at different strategies to provide the two forms of ventilation. No differences on mortality at 28-30 days of age or at approximately term equivalent age were seen between the treatments. The effects of HFOV on chronic lung disease were inconsistent across the trials, but subgroup analysis showed CLD was reduced with HFOV when:

• A high volume strategy for HFOV was used.
• Piston oscillators were used for HFOV.
• Lung protective strategies for CV were not used.
• Randomization occurred at two to six hours of age.
• An inspiratory:expiratory ratio of 1:2 was used for HFOV.

The study appeared in the July 18 issue of the Cochrane Database Systematic Reviews. READ ABSTRACT

Sudden Onset Asthma Exacerbations May Respond Better to Treatment
Children who come to the emergency department with a sudden onset asthma exacerbation (defined as an ED presentation </=3 hours after symptoms begin) may have a more rapid response to treatment than those with a slower onset asthma exacerbation, report U.S. researchers publishing in the July issue of Pediatric Emergency Care. They studied 1184 children, 11% of whom were diagnosed with sudden onset asthma. Sudden onset patients were older, more likely to be white, less likely to have a history of steroid use or asthma hospitalization, and had fewer ED visits for asthma. They were also less likely to receive steroid treatment in the ED, had shorter ED lengths of stay, and were less likely to be admitted to the hospital. READ ABSTRACT

Nasal CPAP in the Delivery Room May Help Prevent Intubation
Dutch researchers who compared two different delivery room ventilation strategies in 207 very preterm infants find a sustained inflation followed by early nasal CPAP delivered through a nasopharyngeal tube leads to better outcomes than repeated manual inflations with a self-inflating bag and mask followed by nasal CPAP in the NICU. Infants in the early nasal CPAP group were less likely to be intubated at <72 hours of age or to have received >1 dose of surfactant. They also required a shorter average duration of ventilatory support and were less likely to have developed bronchopulmonary dysplasia at 36 weeks. The research appears in this month’s Pediatrics. READ ABSTRACT