April 2013

Support RT Legislation

The AARC PACT made its annual trip up Capitol Hill in March to support issues important to you and your patients, but the work is far from over. The AARC is urging all its members to take a moment to write or email their members of Congress in support of the Medicare Respiratory Therapist Access Act. So visit our Advocacy page to learn more about it and then use one of our letter templates to let your elected officials know you support the legislation.

NICU Scoring Methods Found Lacking

The overall quality of NICUs is commonly judged using scoring methods like the Clinical Risk Index for Babies and the National Institutes of Child Health and Human Development “calculator.” University of Michigan researchers publishing in a February issue of Pediatrics suggest these scores do not provide an accurate way to compare one NICU to another. They looked at ten different neonatal mortality risk adjustment scores, finding significant differences in terms of intended purpose in areas such as research, clinical management, and performance. Timing of data collection and inclusion of comorbidity factors were also inconsistent between scoring methods. “Our research shows that these adjusted scores may not always level the playing field when comparing one hospital to another. Moreover, some of these tools are being used in ways they were not originally intended,” study author Robert Schumacher, MD, was quoted as saying. “We hope additional research in this area can both improve the care for patients and allow for reliable comparisons of institutions.” READ PRESS RELEASE

BiPAP, NSIPPV Compare Well in Italian Study

Italian researchers publishing ahead of print in the Journal of Maternal-Fetal Neonatal Medicine on Mar. 14 find equally positive results for the use of bilevel-NCPAP (BiPAP) and nasal synchronized intermittent positive pressure ventilation (NSIPPV) as the primary mode of treatment for extremely/very low birth weight infants with respiratory distress syndrome. The study compared outcomes for 45 patients who received BiPAP and 33 who received NSIPPV. The primary outcomes were length and failure of noninvasive ventilation. Secondary measures included adverse short-long term pulmonary outcomes and multiple doses of surfactant, among others. The authors conclude that both interventions could constitute a valid option to conventional mechanical ventilation in these patients, with theoretical benefits ranging from tidal volume enhancement and improvements of the functional residual capacity to improvements in the mean airway pressure and fewer apnea episodes. READ ABSTRACT

Rapid Test for RSV

Diagnosing respiratory syncytial virus (RVS) in children generally requires moderate to complex techniques performed in a laboratory. However, rapid antigen-detection tests are now available for RSV, and Canadian researchers cover their merits and drawbacks in a new report in this month’s Future Microbiology. The authors also discuss the utility of these tests in clinical practice and what the future holds for this point-of-care diagnostic technique. READ ABSTRACT

Diuretic Therapy for BPD Varies Widely

A new study out of Ohio State University and Nationwide Children’s Hospital suggests more study is needed to determine the safety and effectiveness of long-term diuretic therapy for infants with bronchopulmonary dysplasia (BPD). The investigators reached that conclusion after using 2007-2011 data from the Pediatric Health Information System to determine between-hospital variation in diuretic utilization patterns and variables associated with diuretic use among <29-week-gestation infants with evolving BPD at age 28 days. Among the results:

• During the 54-month study period, 1429 infants at 35 hospitals met the inclusion criteria for BPD at age 28 days, with 1222 (86%) receiving diuretic therapy for a median of nine days.
• 83% of the infants received short courses of therapy; 40% received treatment for more than five consecutive days.
• Furosemide was used in 85% of patients but chlorothiazide had the longest median duration of use, at 21 days.
• The range of infants receiving a diuretic course of more than five days duration varied by hospital from 4% to 86%, with wide between-hospital variation even after adjustment for confounding variables.

The study was published ahead of print in Pediatrics on Mar. 11. READ ABSTRACT