January 2008

Section Bulletin Needs Your Input
The section is currently seeking topics and articles for the 2008 Section Bulletins, and we would like to invite all our members to weigh in by filling out our ONLINE FORM. So start thinking about what you’d like to see in your Bulletins this year, and then suggest those topics via the form. If you’d like to write an article for the Bulletin, you can note that in your comments as well, and one of our Bulletin editors will contact you for more information.

HFOV and Airleak
Chinese researchers who used the repeated measurement method to test the hypothesis that mean airway pressure (MAP) is the major determinate for airleak during high frequency oscillatory ventilation (HFOV) had their hypothesis confirmed. The study involved 13 healthy white rabbits who were ventilated with a Humming V HFOV using high peak pressure to create airleak. MAP was indeed the main independent risk factor for airleak. Tidal volume exerted a lesser effect on airleak than MAP, and frequency did not affect airleak. The study appeared in the December issue of Pediatric Pulmonology. READ ABSTRACT

Classifying Rare Lung Diseases in Children
Cincinnati Children’s Hospital and Medical Center investigators publishing in the December issue of the American Journal of Respiratory and Critical Care Medicine offer a new system aimed at helping clinicians classify rare lung diseases in children. The report is based on data from 11 medical centers in North America, where researchers reviewed 187 biopsies of children under the age of 2 who were being evaluated for diffuse lung diseases such as interstitial lung disease. The investigators were able to classify 88% of the biopsy cases, finding a diverse spectrum of lung diseases that are largely unique to young children. About a quarter were grouped under the label “growth abnormalities” and included conditions like pulmonary hypoplasia. Another group was categorized as “surfactant dysfunction disorders.” According to the authors, the system is helping pathologists arrive at more accurate diagnoses for lung disease in this population, and in some cases is leading to more appropriate treatment. READ ABSTRACT

Factors Influencing Difficult Extubation
A new review out of the United Kingdom has identified key factors in the difficult extubation of very low birth weight (VLBW) infants:

• Ventilation techniques supporting every spontaneous breath are the most efficacious weaning modes.
• Nasal CPAP post extubation reduces the likelihood of incidents leading to the need for reintubation in VLBW infants; however, further work is needed to determine if there are advantages of particular delivery techniques.
• Both methylxanthines and dexamethasone facilitate weaning and extubation; dexamethasone given systemically is effective even when given 21 days or more after birth; the efficacy of low dose dexamethasone merits further investigation.
• Assessments of the efficacy of respiratory efforts and hence the balance of respiratory drive, muscle performance, and respiratory load appear to best predict weaning and extubation success.
• A dedicated staff is essential to the success of weaning and extubation; the value of facilitating the staff via computerized decision making tools requires testing.
• The role adequate nutrition plays in successful extubation merits investigation.

The study appeared in the Dec. 18 Epub edition of the Archives of Disease in Childhood - Fetal and Neonatal Edition. READ ABSTRACT

Ibuprofen May Slow Lung Decline in CF
Could ibuprofen slow lung decline in children with cystic fibrosis? Yes, report researchers from Rainbow Babies and Children’s Hospital and Case Western Reserve University School of Medicine. Their study involved 1,365 patients who took ibuprofen and 8,960 who did not. Doses ranged from 20 to 30 milligrams per kilogram of the patient’s weight, with some patients taking as much as 1,600 milligrams per dose. Patients who took high doses had a 29% reduction in the loss of lung function over 2 to 7 years. Annual incidence of gastrointestinal bleeding was rare in both children who took ibuprofen and those who did not, 0.37% and 0.14%, respectively. The study was published in the December issue of the American Journal of Respiratory and Critical Care Medicine. READ ABSTRACT