March 2013

Specialty Practitioner of the Year: Nominations Being Accepted Now

We’ll be recognizing one of our own at AARC Congress 2013 in Anaheim, and now is the time for nominations. So take a moment to consider a section member for this important award. Our online NOMINATION FORM makes it easy.

Prolonged Ventilation in TOF/PA/MAPCA Patients

A new study out of Stanford University School of Medicine takes a closer look at factors associated with prolonged postoperative respiratory failure in children with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals (TOF/PA/MAPCAs) who undergo unifocalization surgery. Thirty-five consecutive patients who underwent 37 procedures were enrolled in the investigation, with one excluded for single-ventricle anatomy. Twelve patients, or 32%, required prolonged mechanical ventilation. The only risk factor associated with prolonged ventilation was delayed sternal closure. However, patients who developed pneumonia also had a prolonged course. “Our pilot study suggests that clinical features common in this patient population, such as bronchospasm and 22q11 microdeletion, were not associated with more postoperative respiratory failure,” write the authors. The study was published ahead of print by Pediatric Critical Care Medicine on Feb. 22. READ ABSTRACT

Volatile Anesthetic Rescue Therapy: Is it a Good Value?

Stanford researchers also reported on the use of volatile anesthetic (VA) rescue therapy in children with acute asthma in another paper published ahead of print in Pediatric Critical Care Medicine on Feb. 22. The study compared outcomes for children age 2-18 who had a primary diagnosis code for asthma support with mechanical ventilation in the Pediatric Health Information System between 2004-2008. Overall, 1558 children at 40 hospitals were included. Among that group, 47, or 3%, were treated with VA at 11 hospitals. These patients were significantly less likely to receive inhaled b-agonists, ipratropium bromide, and heliox, but more likely to receive neuromuscular blocking agents. They also spent more time on the ventilator and had longer lengths of stay. Charges were significantly higher as well. Aspiration was more common in kids treated with VA, but death and air leak were similar to children not treated with VA. READ ABSTRACT

Differential Effects of Immaturity and NLD on Lung Function in VLBW Infants

German investigators examined the differential effects of immaturity and neonatal lung disease (NLD) requiring invasive mechanical ventilation on lung function in 386 very low birth weight (VLBW) infants who were measured for lung function at a postmenstrual age of 49 weeks. Among the group, 226, or 59%, were born prior to the 28th week of gestation and 247, or 64%, had NLD requiring invasive mechanical ventilation. Lung function testing included tidal breathing measurements, measurement of respiratory mechanics assessed by occlusion test, body plethysmography, SF6 multiple breath washout, forced expiratory flow by rapid thoraco-abdominal compression technique, end-expiratory CO2, exhaled NO (FeNO), and arterialized capillary blood gas analysis. Results linked severe immaturity to reduced tidal volume and increased respiratory rate, reduced forced expiratory flow, and lower respiratory compliance. NLD was associated with increased respiratory and airway resistances, reduced FRC, increased end-expiratory CO2, and lower FeNO. A lower paO2 and higher paCO2 were seen in both severe immaturity and NLD. The study was published ahead of print by Pediatric Pulmonology on Feb. 8. READ ABSTRACT

Asthma Questionnaire Validated in Wider Group of Children

Questionnaires to assess asthma control are recommended by the NIH asthma guidelines, but current questionnaires are not useable across the pediatric age spectrum, nor have many of them been validated in minority or Spanish-speaking children. UCLA researchers tested the Pediatric Asthma Control and Communication Instrument (PACCI) to see how well it would perform in comparison to the Asthma Control Test (ACT), or the childhood ACT for kids age 4-11; the Pediatric Caregiver Quality of Life Questionnaire; and lung function and clinician assessments of asthma. The study involved 265 English speaking and 52 Spanish speaking children presenting for routine asthma care; 44% of the children were African-American. PACCI control showed good internal reliability and strong concurrent, discriminative, and known-groups validity with ACT and Pediatric Asthma Caregiver Quality of Life Questionnaire scores across all age groups and in both languages. The questionnaire also meshed well with clinicians’ ratings of asthma control and showed good accuracy in classifying children with uncontrolled asthma. The study was published ahead of print by the Journal of Allergy and Clinical Immunology on Feb. 21. READ ABSTRACT