February 2013
Winter Bulletin Online Now
Check out our WINTER BULLETIN for informative articles on the use of an LVAD in a patient with Duchenne’s muscular dystrophy and one member’s experience on a quality improvement team aimed at decreasing device related pressure ulcers.
Body Position’s Effect on Ventilation Distribution
Noting that previous studies have indicated that the prone position is advantageous when ventilating preterm infants but little study exists on regional ventilation distribution in this age group, researchers from Australia decided to look at the effect of body position on regional ventilation distribution in 24 ventilated and six spontaneously breathing preterm infants using electrical impedance tomography. The infants were tested in the supine, prone, and quarter prone positions. Results showed regional impedance amplitudes were increased in the posterior vs. anterior lung and in the right vs. the left lung in the spontaneously breathing infants. However, no differences were seen in the ventilated infants. The study also found that ventilation was more inhomogeneous in the ventilated infants than in the healthy infants. The posterior lung filled earlier than the anterior lung in the spontaneously breathing infants while the right lung filled before the left lung in the ventilated infants. The study was published ahead of print by Pediatric Critical Care Medicine on Jan. 9. READ ABSTRACT
Extubation Failure in Infants with Shunt-Dependent Pulmonary Blood Flow
Researchers from the University of Arkansas Medical Center report outcomes from their experience with extubation failure in 55 infants with shunt-dependent pulmonary blood flow. Among the findings:
- Extubation failure occurred in 27% of the infants.
- Of the 15 patients with extubation failure, ten required reintubation and five received continuous positive pressure ventilation without reintubation.
- Three patients had extubation failure in the first two hours after extubation, nine in the 2-24 hour period, and three in the 24-96 hour period.
- Eight patients were extubated in the second attempt after the first extubation failure, with a median duration of mechanical ventilation of two days.
- The median age of patients at extubation was 19 days and median weight was 3.6 kg.
- 38% of the patients were intubated before surgery.
- The most common risk factors for failed extubation were lung disease (46%), cardiac dysfunction (26%), diaphragmatic paralysis (13%), airway edema (6%), and vocal cord paralysis (6%).
- The median duration of mechanical ventilation was four days, median cardiovascular ICU length of stay was 11 days, and median hospital length of stay was 30 days.
- The overall mortality at the time of hospital discharge was 7%.
The study was published ahead of print by Cardiology in the Young in January. READ ABSTRACT
Web-Based Program Ups Tobacco Cessation-Related Behaviors
Can a web-based continuing education program help pediatric respiratory therapists and other clinicians improve their tobacco cessation-related behaviors on the job? That’s the question researchers from the University of Arizona asked in a study that tested the use of the first such program designed for the pediatric setting (dubbed “WeBreathe”) among 40 RTs, 163 nurses, and 12 nurse practitioners at the Children’s Hospital of Philadelphia and the Children’s Hospital, University of Colorado at Denver. The clinicians were randomized to either the three hour program or delayed training. At one month and three month assessments, clinicians who took part in the program were more likely to have increased their tobacco cessation intervention behaviors and they also showed significantly greater levels of the “advise,” “assess,” and “assist/arrange” behaviors included in the training. Clinicians who took the course gave it high marks as well. The study was published ahead of print by Pediatrics on Jan. 14. READ ABSTRACT
Interobserver Variability Common in Pediatric UAO
Pediatric respiratory therapists were also part of a study conducted by investigators at the Children’s Hospital of Los Angeles and University of Southern California Keck School of Medicine to gauge interobserver variability in the clinical assessment of pediatric upper airway obstruction (UAO). RTs, nurses, and physicians in two tertiary care pediatric ICUs performed simultaneous, blinded UAO assessments on 112 children after endotracheal extubation. Agreement between the clinicians was poor for cyanosis and hypoxemia at rest and fair for consciousness, air entry, hypoxemia with agitation, and pulsus paradoxus. Interrater reliability was moderate for stridor and retractions, a situation the authors believe could be marginally improved by dichotomizing the presence or absence of stridor or retractions. They note that the overall incidence of UAO after extubation, defined as stridor plus retractions, could range from 7-22% depending on the number of providers required to agree. The study was published ahead of print by the Journal of Critical Care on Jan. 18. READ ABSTRACT
