September 2007

Congress is Back — We Need to Be Too
Congress is back in session, and that means we all need to redouble our efforts to contact our Senators and Representatives in support of key respiratory legislation, including bills to formally establish pulmonary rehabilitation as a Medicare benefit, repeal Medicare provisions calling for home oxygen patients to assume ownership of their equipment after 36 months, support allied health education, and allow for FDA regulation of tobacco. The AARC is also asking everyone to write their members of Congress, requesting that they support legislation to amend portions of the Part B Medicare law to allow certain respiratory therapists to deliver a broader array of services. You can learn more about these legislative initiatives and how to contact your members of Congress on the AARC’s CAPITOL CONNECTION web site.

Infants Account for Second Highest Hospitalization Rate for MRSA Infection
A new report from the federal Agency for Healthcare Research and Quality shows hospitalizations for methicillin-resistant staphylococcus aureus (MRSA) infections more than tripled from 2000 to 2005, accounting for 368,000 stays, and infants had the second highest rate of hospitalizations after the elderly, accounting for 114.7 stays per 100,000 population.

Other findings from the report:

• Average cost for an MRSA hospitalization was $14,000 versus $7,600 for all other stays.
• Average length of stay was 10.0 days versus 4.6 days for all other stays.
• MRSA hospitalizations were more likely to begin in the emergency department, to be transfers from another hospital, or transfers from long-term care settings.
• The in-hospital death rate for MRSA stays was 4.7% compared with 2.1% for non-MRSA stays.
• The most common conditions associated with MRSA are skin infections (18.9% of all MRSA cases), pneumonia (9%), complications of medical care (16%), and septicemia (7.3%).

READ REPORT

Two Studies Look at Volume Guarantee Ventilation
Researchers from Italy and Ireland have new information to add to the medical evidence on volume guarantee ventilation —

• The Italian study was conducted among ten premature infants in the recovery phase of respiratory distress syndrome who served as their own controls. Investigators compared patient-ventilator interactions and Vt variability as the infants were weaned in various ventilator modes (SIMV/PSV + VG/SIPPV + VG and SIMV + VG). Results showed the VG option, when combined with traditional, patient triggered ventilation, adhered closely to the proposed theoretical algorithm, achieving highly effective ventilation. The report appeared in the August 28 Epub edition of Pediatric Pulmonology. READ ABSTRACT
• The Irish study investigated the effects of triggered and untriggered inflations on PIP and VTe in neonates who were ventilated using the SIPPV and VG modes. The researchers found PIP was 4 cm H2O lower during triggered inflations than untriggered inflations during VG ventilation, although the expired tidal volumes were similar. The study was published in the August 8 Epub edition of the Archives of Disease in Childhood Fetal and Neonatal Edition. READ ABSTRACT

COMFORT Scale Aids in Sedation Management
The COMFORT scale may be effective in reducing the need for sedation in critically ill children on mechanical ventilation, report Korean researchers publishing in the August issue of the Journal of Korean Medical Science. They compared two groups of infants. The first was sedated using their hospital’s PICU sedation protocol along with the COMFORT scale. The second was assessed for sedation prior to using the two tools and served as controls. Significant decreases in the total use of sedatives and analgesics, duration of mechanical ventilation, PICU stay, and development of withdrawal symptoms were seen in patients in the intervention group. The authors conclude, “These findings suggest that application of protocol-based sedation with the COMPORT scale may benefit children requiring mechanical ventilation. READ ABSTRACT

HFNC Equal to nCPAP
The high flow nasal cannula (HFNC) performed well when compared to nasal CPAP in studies conducted in St. Louis and New Jersey. In the first study, researchers used intrapharyngeal pressure (IPP) manometry to measure the IPP generated at flows of 1, 2, 3, 4 and 5 1 min(-1) in 14 infants on HFNC or nCPAP, finding “HFNC delivers significant IPP and is a potentially well tolerated and viable option to provide CPAP at flows of >/=3 min(-1) in infants with respiratory distress.” The second study compared work of breathing in premature infants supported by either HFNC or nCPAP. No differences in WOB were seen between the two groups, leading the authors to conclude, “In these preterm infants with mild respiratory illness, HFNC provided support comparable to NCPAP.” The St. Louis study appeared in the August 30 Epub edition of the Journal of Perinatology. READ ABSTRACT The New Jersey study was published in the August issue of the same journal. READ ABSTRACT

Is It Asthma, or is It Vocal Cord Dysfunction?