November 2011
Fall Bulletin Online Now
The latest edition of our quarterly Bulletin is
up on the SECTION
WEBSITE now, with great articles on
seasonal asthma exacerbations, near infrared spectroscopy,
and a “Notes” column by Section Chair Cindy White
that features our Specialty Practitioner of the
Year.
Quality Improvements Pay Off
Enforcing strict compliance with hand hygiene standards, implementing the Institute for Healthcare Improvement’s ventilator-associated pneumonia “bundle,” and ensuring compliance with hygiene standards for central-line catheters resulted in improved outcomes for patients treated at the University of North Carolina’s women’s and children’s hospitals, report researchers publishing in a recent issue of Health Affairs. In a study that compared outcomes pre and post intervention in one PICU, they found patients admitted after the changes were put into place spent 2.3 fewer days in the hospital, had 2.3% lower mortality rates, and cost the hospital $12,136 less. The projected annual cost savings was approximately $12 million for the PICU in the study. The authors conclude, “Given the modest expenses incurred for these improvements—which mainly consisted of posters for an educational campaign, a training ‘fair,’ roughly $21 per day for oral care kits, about $0.60 per day for chlorhexidine antiseptic patches, and hand sanitizers attached to the walls outside patients’ rooms—this represents a significant return on investment.” READ FULL PAPER
Controller Meds Lead to Better Sleep for Asthmatic Kids
Here’s a hidden benefit of controller meds for children with asthma: Seattle Children’s Hospital investigators find kids who adhere to their asthma prescriptions have fewer sleep problems. Their study surveyed parents about their children’s daily controller medication use and sleep problems such as trouble falling asleep and daytime sleepiness. Sleep problems were common in the group, with 19.4% of parents reporting problems related to falling asleep and 12.1% reporting problems with daytime sleepiness. Children who used a controller medication were less likely to have trouble falling asleep; the finding was statistically significant for those on leukotriene inhibitor medications. Any controller use was associated with less daytime sleepiness. The study was published in the September issue of the Archives of Pediatrics & Adolescent Medicine. READ ABSTRACT
Body Position During CPAP Examined
In the first study of its kind, Australian researchers looked at the effect of body position on regional ventilation in preterm infants on CPAP. Using electrical impedance tomography, the investigators measured changes in global and regional lung volume in 25 infants on CPAP and six spontaneously breathing controls. Infants were tested in the supine, prone, and quarter prone positions. While no differences were seen between positions, other results showed:
- Regional tidal volume was increased in the posterior compared with the anterior lung and in the right compared with the left lung in both groups,
- The posterior lung filled earlier than the anterior lung in the spontaneously breathing infants, whereas in the infants on CPAP the right lung filled before the left lung.
- There was more ventilation inhomogeneity in the infants on CPAP than in the healthy infants.
The authors conclude, “Gravity had little impact on regional ventilation distribution in preterm infants on continuous positive airway pressure or in spontaneously breathing infants in the supine or prone position, indicating that ventilation distribution in preterm infants is not gravity-dependent but follows an anatomical pattern.” The study was published ahead of print in Pediatric Critical Care Medicine on Sept. 15. READ ABSTRACT
Readmissions Common for Kids on HMV
A new study out of UCLA sheds some light on readmissions for children discharged on home mechanical ventilation (HMV). The investigators conducted a retrospective review of 109 HMV patients who were treated at their hospital between 2003 and 2009 and then followed for one year. The non-elective readmission rate among these children was 40%, and nearly half of the readmissions took place within the first three months of discharge. Sixty-four percent of the readmissions were pulmonary or tracheostomy related. Patients who had a change in management within seven days of discharge were also more likely to be readmitted to the hospital shortly thereafter. The authors conclude, “Non-elective readmissions of newly initiated pediatric HMV patients were common and likely multifactorial. Many of these readmissions were airway-related, and some may have been potentially preventable.” The study was published ahead of print in Pediatric Pulmonology on Sept. 7. READ ABSTRACT
