June 2010

Year of the Lung: Great Ideas Online
2010 is the Year of the Lung, and the AARC is a key partner in the international effort to promote the event. We’ve been featuring Year of the Lung ideas, resources, and activities on the AARC website—neatly categorized into “Do It,” “Learn More,” “Share It,” and “Focus On” sections to ensure there’s something for everyone—all year long. So head over to the PAGE and see how you can get involved. It’s a great way to showcase respiratory therapists as the lung health experts in your community. 

ATS Conference: Presentations of Interest
These papers from the recent American Thoracic Society conference may be of interest to members of our section:

• Australian researchers who followed children from a 1957 birth cohort until the age of 50 find those who were classified as having severe asthma in childhood had an adjusted risk of developing COPD that was 31.9 times that of children without asthma. No increased risk was seen for children with mild asthma. READ PRESS RELEASE
• California investigators evaluated two exercise protocols in 56 healthy children without asthma or allergy—a constant work rate exercise test and a progressive exercise test—finding nearly half the children had at least one abnormal result on pulmonary function tests conducted after the exercise. The finding surprised the researchers, who call for more study to determine how heavy exercise impacts children. READ PRESS RELEASE

Ventilation Techniques, Oxygen Delivery for Preterm Infants
A new study from investigators taking part in the Neonatal Research Network is shedding light on ventilation techniques and oxygen delivery for preterm infants. The researchers randomly assigned 1316 preterm infants to either intubation and surfactant treatment within an hour of birth, or CPAP treatment in the delivery room followed by limited ventilation for two weeks. The infants were randomly assigned to either 85-89% oxygen saturation or 91-95% oxygen saturation as well. Infants treated with CPAP required less frequent intubation as well as fewer days on a ventilator than those who were intubated within an hour of birth, but the rate of bronchopulmonary dysplasia or death did not differ significantly between the two groups. The risk of severe retinopathy of prematurity (ROP) was lowest among survivors in the lower blood oxygen saturation group, but death before nursery discharge occurred more frequently among infants in that group as well. “More research is needed to determine what is a safe lower level of oxygen saturation to either prevent or ameliorate ROP,” notes Dr. Pablo Sanchez, a study author from UT Southwestern. “Until then, physicians should be cautious about targeting low oxygen saturation levels because it may lead to a higher chance of death.” The research was published in the New England Journal of Medicine. READ PRESS RELEASE

HFOV Found Safe and Effective for Preterm Infants
A meta-analysis conducted by Belgium researchers concludes high frequency oscillatory ventilation (HFOV) is as safe and effective as conventional ventilation in preterm infants with respiratory failure. The Prevention of Ventilator Induced Lung Injury Collaborative Group reviewed ten trials and 3229 infants with a mean gestational age at birth of 27.3 weeks and mean birth weight of 989 grams. No differences according to sex, gestational age, birth weight below the 10th percentile, presence of chorioamnionitis, oxygenation index, or use of antenatal corticosteroids were seen for the three primary outcomes: death, bronchopulmonary dysplasia, or severe neurologic adverse event. Other results showed:

• A significant benefit for HFOV was seen for all three primary measures if randomization occurred between one and four hours after intubation.
• HFOV was not associated with an increased risk of gross pulmonary air leak, but there was a suggestion of an increase in risk of pulmonary interstitial emphysema.
• In comparison with conventional ventilation, HFOV reduced the need for surgical closure of patent ductus arteriosus and was associated with a reduction in retinopathy of prematurity stage 2 or higher.

The study was published in The Lancet. READ ARTICLE

Emergent Intubations Linked to Complications
Researchers from Connecticut Children’s Medical Center who conducted a retrospective review of all intubations occurring outside of the operating room over a two year period in a 122-bed children’s hospital find emergent intubations made up slightly more than half of the total at 56%. These intubations were three times more likely than elective intubations to be associated with complications. The most common complications were desaturations (29% of all intubations), hypotension (16%), and bradycardia (7%). Emergent intubations were also twice as likely as elective intubations to take place during off hours, defined as on the weekends or between 5 p.m. and 8 a.m. during the week. The study appeared in the May issue of Pediatric Critical Care Medicine. READ ABSTRACT

Have You Connected Yet?
As most section members know by now, our listserve has migrated to the AARC’s new social media site, AARConnect. You may be sending and receiving messages via the new site, but have you updated your Profile Page yet? If not, GO THERE now, click on “Complete your profile” on the top right hand corner, and fill out the form. Don’t forget to upload a picture of yourself as well. AARConnect is a great way for us all to learn a little more about each other, but it only works if everyone uses the site to its full potential!