July 2011

Adopt-a-Company is Your Chance to Connect with Your Community
As neo/peds RTs, we don’t see COPD patients on the job. But as therapists, we know COPD could very well be in the future of our young patients if we don’t do our part to educate the public about this chronic lung condition. Now the AARC is partnering with DRIVE4COPD in a new campaign designed to help us deliver COPD education and screening to the people who need it most: working Americans who may be at risk for this chronic lung condition but don’t even know it. Find out how you can help by adopting a company in your community. READ MORE

Five Practices Improve Outcomes for Premature Infants
Massachusetts researchers report good outcomes from the implementation of five practices aimed at limiting mechanical ventilation, supplemental oxygen, and bronchopulmonary dysplasia in infants born before 33 weeks gestation. The five practices include:

Exclusive use of bubble continuous positive airway pressure (bCPAP).
Provision of bCPAP in the delivery room.
Strict intubation criteria.
Strict extubation criteria.
Prolonged CPAP to avoid supplemental oxygen.

A comparison of 61 infants born before the five practices were put into place with 60 infants born after the implementation of the practices showed:

For infants born at 26-32 weeks’ gestation, intubation in the first 72 hours decreased from 52% to 11% and surfactant use decreased from 48% to 14%.
In all infants, the mean ± SD fraction of inspired oxygen requirement in the first 24 hours decreased from 0.27 ± 0.08 to 0.24 ± 0.05, days of oxygen decreased from 23.5 ± 44.5 to 9.3 ± 22.0, and days of mechanical ventilation decreased from 8.8 ± 27.8 to 2.2 ± 6.2.
Hypotension decreased from 33% to 15%.
The percentage of infants with bronchopulmonary dysplasia was 17% before and 8% after.
Nurse staffing ratios remained unchanged.

The study was published online by Pediatrics on June 13. READ ABSTRACT

Defining the Target FiO2
Italian investigators who set out to define the target FiO2 in the lung recruitment phase during high frequency oscillatory ventilation (HFOV) of preterm infants find an optimal lung volume strategy (OLVS), defined as FiO2≤0.25 during the recruitment phase, produces better outcomes than a strategy leading to an FiO2>0.25 (No-OLVS). Prior to surfactant administration 28 infants in the OLVS group received a significantly higher continuous distending pressure than the 23 infants in the No-OLVS group, 12.8±1.1 cmH2O vs. 11.2±1.3 cmH2O They also had a significantly lower FiO2, 0.25±0.01 vs. 0.35±0.06. OLVS was significantly associated with less need for surfactant doses, a decreased risk of ductus arteriosus surgically ligated, and a lower number of ventilation hours before extubation. The study was published ahead of print in Minerva Anestesiologica on June 29. READ ABSTRACT

IOS No Replacement for the FEV1
A new study out of France that compared the accuracy of impulse oscillation system (IOS) parameters obtained during methacholine challenge with the FEV1 finds IOS is not as accurate as the FEV1. Researchers measured FEV1 and resistances at 5 and 20 Hz, reactance at 5 Hz, impedance at 5 Hz, and resonant frequency in 227 children with suspected asthma, analyzing the data in 72 patients with asthma, 122 with chronic cough and nonspecific respiratory symptoms, and 33 with allergic rhinitis. According to the results:

All IOS parameters changed significantly during the tests but only changes in X5 were significantly different between responders and nonresponders.
Changes in IOS parameters were not correlated with changes in FEV1 apart from a weak correlation for X5.
The receiver operating characteristic curve for changes in X5 showed a best decision level for a 50% decrease in X5, with a sensitivity of 36% and a specificity of 85%. Results were not different in the asthma group.

The study was published ahead of print in Pediatric Pulmonology on June 1. READ ABSTRACT

Post-Natal Corticosteroids Linked to Reduced Expiratory Flows Later in Childhood
Corticosteroids are routinely given to premature infants to minimize the risk of bronchopulmonary dysplasia (BPD), but the jury is still out on how these drugs impact lung function in these children in later childhood. Australian investigators decided to find out in a study conducted among 105 children who underwent lung function assessments at age ten. While spirometry in the children who had developed BPD as infants was not significantly different than that seen in the non-BPD group, and antenatal steroid treatment alone did not adversely affect airflow, children who received post-natal corticosteroids had significantly lower expiratory flows than those who did not. Days on oxygen and days ventilated were statistically significant but weak predictors of airflow at ten years of age. The study was published ahead of print in the Journal of Paediatrics and Child Health on June 28. READ ABSTRACT