November-December 2012

Notes from the Section

• Congratulations to Rob DiBlasi for receiving our 2012 Specialty Practitioner of the Year Award at AARC Congress 2012 in New Orleans.
• Read more about Rob in the FALL edition of our Section Bulletin. We also highlight the other folks nominated for this important award this year and share an informative article on respiratory management of patients with Duchenne’s Muscular Dystrophy.

How Cigarette Smoke Hurts Small Lungs

Researchers from the Mayo Clinic are helping to explain how cigarette smoke adversely impacts the lungs of fetuses and premature infants. They exposed human fetal airway smooth muscle cells of deceased 18-20-week-old human fetuses to various levels of cigarette smoke, using gel analysis to determine changes in caveolae and their proteins, cell proliferation, and death. Changes calcium levels were examined using fluorescent Ca2+ sensitive dyes and real-time microscopic imaging. Cells exposed to cigarette smoke had increased levels of calcium and caveolar proteins, similar to the effects of inflammation in asthma. Even low levels of cigarette smoke increased markers of cell proliferation, while higher smoke levels caused cell death. The authors believe these results show the detrimental effects of cigarette smoke are caused, at least in part, by altered caveolar signaling in developing airway smooth muscle cells. Increased caveolar proteins, calcium, and cell proliferation can make the airways thicker and more responsive to bronchoconstrictors, thus increasing airway contractility and making it more difficult for the baby to breathe. The study was presented at ANESTHESIOLOGY™ 2012. READ PRESS RELEASE

NAVA Facilitates Weaning in Some CDH Patients

Italian investigators report outcomes from the use of neurally adjusted ventilator assist (NAVA) to wean infants with congenital diaphragmatic hernia (CDH) from mechanical ventilation in a study published ahead of print in the Journal of Maternal-Fetal & Neonatal Medicine on Nov. 5. Five infants who were submitted to primary repair, and five in whom the patch was limited to the diaphragmatic postero-latral area, had an active EAdi signal and were successfully weaned. NAVA was not feasible in two infants with hemidiaphragm agenesis due to an inability to capture the EAdi signal. Compared to pressure support ventilation, NAVA significantly improved oxygenation-linked indexes and paCO2 while reducing PIP. The authors conclude, “The lower risk of lung injury in NAVA appears compatible with current ventilatory strategies considered useful in CDH.” READ ABSTRACT

RFM Helps Clinicians Avoid Excessive PIP, VT, During Neonatal Resuscitation

A respiratory function monitor (RMF) helped to reduce peak inspiratory pressures and tidal volumes during neonatal resuscitation in a study conducted in Germany. The investigators educated 37 previously untrained medical professionals to ventilate a neonatal preterm manikin using an RFM to measure PIP and VT. While graphical representations were shown during the training, they were blinded during subsequent recordings. Median PIP dropped from 32.3 cm H2O prior to the training to 17.8 cm H2O immediately following the training. Median VT went from 6.7 to 3.5. The improvements were largely sustained at a one month follow up, with median PIP coming in at 18.7 and median VT at 4.1. The study appeared in the September edition of the Journal of Perinatal Medicine. READ ABSTRACT

Time is of the Essence

Making sure children who present to the emergency department with an acute exacerbation of asthma are treated with oral corticosteroids within one hour could significantly cut down on the overall length of ED stay, report University of Connecticut researchers publishing in the October edition of the Journal of Asthma. They compared length of stay (LOS) for children age 2-18 who were treated within 60 minutes with those who were treated at 61 minutes or longer. Children who were not prescribed oral corticosteroids in the ED, those with significant comorbidities, those who were already taking corticosteroids, or those who had taken them within seven days were excluded. No differences were seen in age, gender, insurance, or disposition among the two groups of children. Overall, children treated within 60 minutes had a 25 minute decrease in LOS. “With large numbers of asthma visits, a 25-minute decrease in LOS for each child could have a significant impact on patient throughput in the ED,” write the authors. The study was based on a retrospective chart review of 882 patients. READ ABSTRACT