October 2007

Section Meeting Scheduled for Congress
Section members are encouraged to be on hand for our annual business meeting at the AARC Congress. We’ll be gathering on Sunday, December 2, at 4:20 p.m., with Section Chair Michael Tracy presiding. Bring your questions and concerns and plan to take part in the discussions.

Beware of Milk Allergy in Pulmicort Patients
An AARC member recently raised a little-recognized concern regarding the use of Pulmicort in a patient with lactose allergy. A posting on the AZ-AIR web site details the problem, noting patients with true milk allergy could experience life threatening anaphylaxis in response to lactose contained in dry powder inhalers. However, people suffering from lactose intolerance, defined as the inability to absorb lactose from the intestine, generally will not have problems using the inhalers, as the amount of lactose in these inhalers is small and most of it is deposited in the lungs. READ MORE

Pumpless Arteriovenous Carbon Dioxide Removal Effective in Severe Asthma
Louisiana State University researchers found pumpless arteriovenous carbon dioxide removal was effective in removing enough carbon dioxide to allow application of a protective ventilatory strategy in four pediatric patients in severe hypercapnic respiratory failure due to severe asthma. All were first intubated and managed with positive pressure ventilation, but despite standard pharmacological treatment, progressive hypercapnia and acidosis rapidly developed, requiring high levels of positive pressure ventilation. Treatment with pumpless arteriovenous carbon dioxide removal reduced Pco2 to more acceptable levels and pH improved, despite reductions in ventilatory frequency and tidal volumes to safe levels. None of the patients required blood cell or platelet transfusions, and none suffered complications from either the treatment or mechanical ventilation. All four patients were discharged without sequelae. The study appeared in the September 25 Epub edition of Critical Care Medicine. READ ABSTRACT

NI-PSV Versus NCPAP in VLBW Infants
Investigators from the University of Miami who compared the effects of non-invasive pressure support ventilation (NI-PSV) and NCPAP on tidal volume, minute ventilation, gas exchange, breathing effort, and chest wall distortion in 15 very low birth weight (VLBW) infants find NI-PSV does not increase minute ventilation, but does lower inspiratory effort and reduce chest wall distortion, effectively unloading the patient’s respiratory pump. The researchers measured these parameters while the infants were on NCPAP 5.3 +/- 0.6 cm H2O and on NI-PSV with 7.9 +/- 1.3 cm H2O above NCPAP of pressure support. The study appeared in the August issue of Pediatric Pulmonology. READ ABSTRACT

Optimizing Temperature and Deadspace Improves Analysis of Multiple Breath Washout
Sub-optimal adjustment of the mainstream molar mass (MM) signal for temperature and external deadspace may lead to analysis errors in infants with critically small tidal volume changes who are assessed for lung volume (FRC) and ventilation inhomogeneities with ultrasonic flowmeter and multiple breath washout. To overcome this problem, Swiss researchers designed a new analysis method with optimized temperature and deadspace settings. Researchers found the new method to be more robust to variations in deadspace, and comparison between the old and new methods showed systematic differences and a wide scatter. The investigation appears in this month’s Pediatric Pulmonology. READ ABSTRACT