March 2008

Recruit a New Member to the Section
Ensuring children receive the best respiratory care possible is the goal of everyone in the Neonatal-Pediatric Section. One of the best ways we have to achieve that goal is to increase our membership so that the thoughts and ideas of more RTs are added to our discussions on the section e-mail list and in our section publications. For that reason, we’re asking everyone to step up and recruit a new member to the section this year. Joining is quick, easy, and can be done right online at any time of the year (not just during an AARC member’s annual renewal). So e-mail this link to your colleagues today and ask them to join you in the Neonatal-Pediatric Section.

If you have colleagues who have yet to join the AARC, direct them here. They can join the Association and the section at the same time!

PIP, tidal volume, and volume guarantee ventilation in the neonate
The peak inflating pressure (PIP) for each ventilator inflation during volume guarantee (VG) ventilation in infants is adjusted to ensure expired tidal volume is close to the set tidal volume. However, clinicians often note differences in PIP for triggered and untriggered inflations. Australian researchers publishing in the January issue of the Archives of Disease in Childhood: Fetal and Neonatal Edition investigated the effects of triggered and untriggered inflations on PIP and tidal volume in 10 infants ventilated using assist control (synchronous intermittent positive pressure ventilation) and VG modes. Among the 6,540 inflations analyzed in the study, 62% were triggered, and these inflations had a significantly lower mean PIP than untriggered inflations. However, no significant difference in the tidal volume was seen between the two types of inflations. A change of about 5 cm H2O in PIP was seen when a triggered inflation was immediately preceded or followed by an untriggered inflation. The change in PIP was less than 3 cm H2O between adjacent inflations of the same type. READ ABSTRACT

Remifentanil Leads to Earlier Awakening, Extubation
Brazilian researchers publishing in the February issue of Paediatric Anaesthesia find remifentanil may be a good alternative to morphine for sedation and analgesia during mechanical ventilation of premature neonates. They compared the two medications in 20 infants with respiratory distress syndrome. The infants were randomly assigned to either continuous infusion of morphine or remifentanil, and outcome measures included length of time to awaken and extubate. Results showed time to awakening was 18.9-fold longer with morphine and time to extubation was 12.1-fold longer. Since good quality sedation and analgesia were achieved in both groups and no major side effects were noted, the authors believe remifentanil may have a role to play in sedation and analgesia in premature infants. However, they call for more study before recommending remifentanil in general practice. READ ABSTRACT

N-CPAP Doesn’t Affect Cardiac Output
Although nasal CPAP is commonly used in NICUs, little is known about its hemodynamic consequences. Austrian researchers decided to investigate the issue in a new study conducted among 21 preterm infants who were measured for standard hemodynamic factors with and without CPAP administration. No significant differences were noted in stroke volume, left ventricular diastolic diameter, fractional shortening, or aortic velocity-time integral. The n-CPAP level did not influence CO or have any echocardiographically detectable hemodynamic effects. “Our data imply there is no need to withhold n-CPAP support to prevent circulatory compromise in these infants,” write the authors. The study appeared in the February issue of the American Journal of Perinatology. READ ABSTRACT

Comparing Open and Closed Suctioning
A new study out of Australia illustrates the differences between open suction (OS) and closed suction (CS) in infants receiving synchronized intermittent mandatory ventilation (SIMV) and high frequency oscillatory ventilation (HFOV). The research involved 20 neonates receiving SIMV and 10 receiving HFOV. No differences were found between OS and CS for maximum DeltaVL or trec during SIMV; during HFOV trec was longer during OS but there was no difference in the maximum DeltaVL of 0.1 mV. The only significant difference in physiological measurements was a small reduction in SpO2 with CS in the SIMV group. The study was published in the February 27 Epub edition of Archives of Disease in Childhood: Fetal and Neonatal Edition. READ ABSTRACT