October 2010

AARC Congress Coming Up Soon; Program Online Now
The AARC will be heading to Las Vegas, NV this Dec. 6–9, and if the Advance Program is any indication, it should be a great meeting for Neonatal-Pediatric RTs. Topics range from hot topics in pediatric transport, to closed-loop FiO2 control, and challenges in non-invasive pediatric ventilation. This year’s premier lectures, the Egan and Kittredge, focus squarely on issues we all care most about as well: The Mechanical Ventilator—Past, Present, and Future, and COPD Heterogeneity: What This Will Mean in Practice. Also, don’t miss out on your section’s annual membership business meeting held Wednesday, Dec. 8th at 11:25 am. It’s your opportunity to hear what’s new in your section and voice your opinion about what you’d like to see done in 2011. So check out the program, and then register by Oct. 31 for earlybird savings.

Plan Now to Contribute an Article to a 2011 Issue of the Bulletin
Our Bulletin editors have done a great job of recruiting articles for publication this year, and we’d like to keep the momentum going in 2011. If you have topic that you’d like to address, consider writing a short article on it (500-700 words) and submitting it for publication to CYNTHIA WHITE or REBECCA JACKVONY. Deadlines for the 2011 issues are: Winter-Jan. 1; Spring-April 1; Summer-July 1; Fall-Oct. 1.

Protocol Clarifies Problematic Severe Asthma in Kids
Using data collected in a study involving 54 school-aged children with problematic severe asthma (PA), defined as insufficient asthma control despite level 4 treatment according to GINA, and 39 aged matched controls with controlled persistent asthma (CA), Swedish researchers developed a noninvasive protocol to help characterize factors predicting PA. The protocol consisted of questionnaires, spirometry, methacholine provocation, FENO and nasal air measurements, and blood sampling for inflammatory biomarkers and atopy. Children in the PA group also underwent computerized tomography of the sinuses and lungs. Sixty-one percent of the PA children were found to have therapy-resistant asthma, with the rest having difficult-to-treat asthma due to other factors. Results linked PA to parental history of asthma, lower socioeconomic status, less physical activity, and more comorbidity with rhinoconjunctivitis. These children also had lower FEV1 values, but they did not demonstrate increased bronchial hyperresponsiveness. The study appeared in the Sept. 30 Epub edition of Pediatric Allergy and Immunology. READ ABSTRACT

Delivering Noninvasive HFOV Via Nasal Prongs
Can noninvasive high frequency oscillatory ventilation (nHFOV) be delivered through nasal prongs? Italian researchers set out to answer that question in a laboratory study. The investigators developed customized sealed circuits to connect a SM3100A oscillator to a neonatal lung model to evaluate the effect of applying HFOV via two different sized nasal prongs on delivered tidal volume and pressure. Among the findings:

• Volume delivered by peak-to-peak oscillation, ventilation, and pressure significantly differed among the interfaces, being higher for large cannulae and the control circuit.
• The interposition of a large or small nasal prong reduced volume to 56 and 26%, ventilation to 32 and 9%, and mean pressure to 83 and 79%, respectively, of the values measured for the direct connection of the oscillator to the test lung.
• Volume and ventilation were inversely related to frequency, which was particularly evident with larger diameter circuits due to higher delivered tidal volume.
• Increasing ventilation was associated with larger tidal volume and nasal prong diameter.

The authors conclude it is technically possible to deliver nHFOV using common nasal prongs, but note that efficiency of tidal volume delivery is significantly affected by prong diameter. The study was published in the Sept. 21 Epub edition of Intensive Care Medicine. READ ABSTRACT

PCV-7 Vaccine Linked to Nasopharyngeal Acquisition of Pneumococcal Strain
A new study out of the Netherlands finds the pneumococcal conjugate vaccination (PCV-7) increases the nasopharyngeal acquisition of pneumococcal serotype 19A, a leading cause of respiratory pneumococcal disease. The research was conducted before widespread use of the PCV-7 vaccine. Investigators randomly assigned 948 infants to either a 2 dose group, 2 + 1 dose group, or no vaccination. “At 24 months and after having completed the vaccine series, the cumulative proportion of participants with acquisition of a new serotype 19A clone in the 2 + 1-dose group was 16.2% (53 of 327) vs. 9.2% (28 of 303) in the unvaccinated control group,” write the authors. “The cumulative proportion in the 2-dose group was also higher than in the unvaccinated group but did not reach statistical significance (13.2%; 42 of 318 children).” They published their findings in the Sept. 8 issue of JAMA. READ PRESS RELEASE

Early Lung Disease Patterns Predict CLD
University of North Carolina researchers publishing in the Aug. 5 Epub edition of the Archives of Disease in Childhood: Fetal and Neonatal Edition link the incidence of chronic lung disease (CLD) in very preterm infants to early patterns of respiratory disease. The study involved 1204 infants born at 23-27 weeks gestation who were classified into three groups: early and persistent pulmonary dysfunction (EPPD), early recovery of pulmonary function followed by deterioration (PD), or consistently good pulmonary function characterized by low FiO2 (Low FiO2). Results showed:

• CLD was diagnosed in 69% of infants with EPPD, 52% with PD, and 17% in the Low FiO2 group.
• Birth weight z score <-1 conveyed information about CLD risk in all three groups and was the major risk factor for infants in the Low FiO2 group.
• Mechanical ventilation at 7 days was associated with increased risk in the PD and EPPD groups, but not the Low FiO2 group.

READ ABSTRACT