September 2008

National Respiratory Care Week: How Will You Celebrate?
If your facility is looking for ways to celebrate this year’s National Respiratory Care Week, coming up October 19-25, the AARC can help. The Association has placed some great resources on its RC WEEK PAGE, and if you can’t find something to pique your interest there, you can also consider hosting one of our special events, such as the HIGH SCHOOL CAREER PROJECT or the VENTILATOR 5K.

Need to purchase RC Week theme products? Find them in the AARC STORE.

Air Leak Test Doesn’t Predict Extubation Failure
A new study conducted by researchers at two major American medical centers finds no link between an endotracheal tube airleak and successful weaning from mechanical ventilation in pediatric patients. The study involved patients age 18 or younger who were intubated for at least 24 hours. Extubation failure was linked to a longer median length of ventilation, while success was associated with the use of postextubation noninvasive ventilation. Absence of the airleak for the duration of mechanical ventilation, seen in 10 patients, did not predict extubation failure. In addition, the airleak test was >/=30 cm H2O before extubation in 28 out of 59 patients, but 23 of them were still successfully extubated. “Pediatric patients who are clinically identified as candidates for an extubation trial but do not have an endotracheal tube airleak may successfully tolerate removal of the endotracheal tube,” conclude the authors. The study was published in the August 1 Epub edition of Pediatric Critical Care Medicine. READ ABSTRACT

NPPV Improves Outcomes for Pediatric ICU Patients
French investigators publishing in the August 19 Epub edition of Intensive Care Medicine report good results for the use of noninvasive positive pressure ventilation (NPPV) in unloading the respiratory muscles and improving clinical outcome in 12 pediatric ICU patients with acute moderate hypercapnic respiratory insufficiency. NPPV resulted in an increase in tidal volume of 33%, an increase in minute ventilation of 17%, and decreases in esophageal and diaphragmatic pressure time product of 49% and 56%, respectively. This improvement in alveolar ventilation caused the mean partial pressure in carbon dioxide to drop from 48 to 40 mmHg and the respiratory rate to decline from 48 to 41 breaths per minute. READ ABSTRACT

Less Practice Variation Seen When Therapies Have Strong Scientific Basis
Do pediatric hospitalists deliver the same care from institution to institution? Researchers from Brigham and Women’s Hospital/Harvard Medical School decided to find out with a new survey of hospitalists and their use of 14 common inpatient therapies, including those related to respiratory care. The investigators sent the survey to 320 hospitalists from U.S. and Canadian facilities, with 213 responding. Results showed less practice variation for therapies with a strong scientific basis, while more variation was seen when the therapy in question was less well documented. In the case of albuterol and corticosteroid use in patients with asthma, little variation was seen, with only 4-6% of respondents reporting rarely using them. Just 12% reported little use of systemic dexamethasone in bronchiolitis. Overall, variation in the use of proven therapies was about 15%, versus about 44% for unproven therapies. “To decrease undesirable variation in care, a stronger evidence base for inpatient pediatric care must be built,” write the authors. The study was published in the July issue of the Journal of Hospital Medicine. READ ABSTRACT

“Time Out” for Treatment
Children with cystic fibrosis (CF) must adhere to their care plan in order to maximize outcomes, and when they rebel against the daily regimen, parents are often at their wit’s end. University of South Carolina researchers tested the ability of a “time out” based discipline strategy to alleviate the problem, finding when parents used it to discipline kids who were refusing treatment requests, the behavior was ameliorated. Parents, in turn, were less likely to seek out professional help to get their children to comply with their treatments. The latter could be particularly important for these families, report the authors, because parents with children who have CF are already spending a considerable amount of time on medical appointments and interventions. The study was published in the July 7 Epub edition of Disability and Rehabilitation. READ ABSTRACT