November/December 2009

Notes from the Section

• The AARC INTERNATIONAL RESPIRATORY CONGRESS is coming up Dec. 5–8, and we’d like to invite all of our section members who are planning to attend to come to the section business meeting on Sunday from 11:20 a.m.–12 noon.
• Congratulations to Tiffany Mabe, who was just elected to our chair-elect position. Tiffany will serve in that capacity until the end of 2010, when she will assume the chair position from current chair, Brian Walsh.
• The Fall edition of our Section Bulletin is ONLINE now—take a few moments to read a great article on acute chest syndrome and sickle cell disease.

MDIs with Spacers: RTs Participate in Study of What Works and What Doesn’t
A new study out of Canada looked at factors leading emergency departments to adopt or not adopt the use of MDIs with spacer devices, finding several common strategies that lead to success. The investigators used focus group interviews with physicians, nurses, and RTs, along with individual interviews with patient care and medical directors, at nine pediatric hospitals to come up with their results. They found EDs were more likely to have implemented MDIs with spacers if they had:

• Active participation of all professional groups in the adoption process.
• A well-planned and executed educational component for staff, patients, and families.
• The MDI/spacer included in a clinical protocol/pathway.

Barriers to adoption included:

• Lack of leadership in the form of a research champion.
• Lack of consensus about the benefits of MDI/spacers among staff.
• Perceived resistance from patients/parents.
• Perceived increased cost and workload associated with MDI/spacer use.

The study appeared in the October issue of Implementation Science. READ ABSTRACT

RTs Outperform Docs on Intubation
Respiratory therapists outperformed both NICU fellows and pediatric residents in a study aimed at assessing neonatal intubation skills. The Canadian study involved postgraduate years 1 and 3 pediatric residents, neonatal-perinatal medicine subspecialty residents and fellows, and NICU RTs with earlier National Resuscitation Program training. Successful intubation rates for the three groups were 100% for the RTs, 69% for the NICU fellows, and 63% for the pediatric residents. The authors call the time taken to intubate by pediatric residents and neonatal fellows “concerning.” The study was published in the Oct. 8 Epub edition of the Journal of Perinatology. READ ABSTRACT

Low Pressure Alarm Failure: A Potential Problem in CPAP Treatment
Austrian researchers who compared the relation between ventilator flows, size of the nasal prongs used for CPAP in preterm infants, and pressure generated within the ventilator circuit due to the flow resistance of the prongs have uncovered a situation that could result in problems with the alarms. Specifically, when flow rates are high, CPAP levels are low, and prongs are small, the resistance of the prongs will create enough dynamic pressure within the ventilator circuit to permit the ventilator to compensate a large leakage flow by closing the expiratory valve. If the prongs become dislodged, the pressure within the ventilator circuit will not decrease below the alarm level, and the machine will not be able to generate an alarm. The study was published in the Oct. 17 Epub edition of the European Journal of Pediatrics. READ ABSTRACT

Pre-ED Communication Works, But Be Specific
Parents who are able to call a clinician during their child’s asthma attack are more likely to take recommended measures before heading to the emergency department, report researchers from Rhode Island Hospital. They compared 104 patients whose parents did speak with a clinician with 95 whose parents did not communicate with a clinician prior to going to the ED, looking specifically at whether the parents administered short-acting beta-agonists (SABAs), increased dosing frequency of SABAs, and administered an oral corticosteroid. Parents who spoke with a clinician were more likely to administer an SABA and oral corticosteroid, but they were not more likely to increase dosing frequency of the SABA. “Clinicians providing telephone advice to parents need to provide explicit instructions about medication administration, emphasizing the frequency with which SABAs should be administered,” write the authors. The study was published in the November issue of the Journal of Asthma. READ ABSTRACT