May 2013

Spring Bulletin Online Now

We’ve just published the Spring edition of our Section Bulletin, with great articles on gas exchange and nutrition monitoring of critically ill, mechanically ventilated patients, and new strategies to reduce skin injury in pediatric NIV. Section Chair Cynthia White encourages members to begin brainstorming nominees for this year’s Specialty Practitioner of the Year award in her Notes column as well. READ ISSUE

Gas Exchange Measurement: Comparing Two Devices

Section member Craig Smallwood is the co-author of a new study published ahead of print by Clinical Nutrition on Mar. 22 that compared oxygen consumption (VO2), carbon dioxide elimination (VCO2), resting energy expenditure (REE), and respiratory quotient (RQ) in mechanically ventilated children using two indirect calorimetry devices: the E-COVX® (gas sampling at the airway) and the Vmax® (gas sampling at the humidifier and ventilator exhaust). The final analysis included steady state data from 19 tests. Among the findings:

• The correlations coefficients for measurements by the two devices were r = 0.903(P < 0.001), 0.955(P < 0.001), 0.944(P < 0.001), and 0.484(P < 0.05) for VO2, VCO2, REE, and RQ, respectively.
• The mean percentage bias (limits of agreement) for VO2, VCO2, REE, and RQ values between the two methods (Vmax-E-COVX) was 0.2 (-41.8-42.3), -0.8 (-21.8-20.1), -2.2 (-33.9-29.6), and 1.9 (-21-24.9), respectively.

Smallwood and his colleague conclude, “Despite strong correlations and small mean biases for VO2, VCO2, and REE obtained by the Vmax® and E-COVX®, the limits of agreement were beyond the clinically acceptable range. These devices should not be used interchangeably for gas exchange measurements in mechanically ventilated children.” READ ABSTRACT

For more on the use of indirect calorimetry and gas exchange monitoring in the pediatric population, read Smallwood’s article in the Spring edition of our section Bulletin.

Survey Shows Need for CPAP Suctioning Best Practices

Ohio State University investigators who conducted a web-based survey among a convenience sample of NICU RNs and RTs at eight Midwestern hospitals to gauge suctioning practices for patients on nasal CPAP believe their results indicate a need to develop best practices for nasal CPAP suctioning. The survey addressed the frequency of suctioning, assessment parameters used to determine the need for suctioning, and techniques used to suction. Demographic data was collected on the respondents as well. Results showed decision making related to suctioning varied widely, as did the frequency of suctioning and suctioning techniques. “Despite the treatment of respiratory distress with nasal CPAP, there are no best practice guidelines for providing nasopharyngeal and oropharyngeal suctioning for maintenance of a patent airway,” write the authors. “Future randomized controlled clinical trials are needed to develop best practices for nasal CPAP suctioning.” The study was published in the April edition of Advances in Neonatal Care. READ ABSTRACT

Factors Leading to CPAP Failure

Preterm infants are increasingly being managed with CPAP, but some infants ultimately fail on the treatment. Australian researchers looked at 297 infants born at 25-32 weeks gestation who were initially placed on CPAP to see which factors were most often associated with CPAP failure. Among the group, 65, or 22%, failed CPAP and required intubation after less than 72 hours. CPAP failure was more common among infants with a lower gestational age and was predicted by an FiO2 of ≥0.3 in the first hours of life. These infants were also more likely to have unremitting respiratory distress syndrome and require prolonged respiratory support and oxygen therapy. They had a significantly higher risk of death or bronchopulmonary dysplasia at 25-28 weeks gestation as well, and a higher risk of pneumothorax at 29-32 weeks gestation. The study was published ahead of print by Neonatology on April 4. READ ABSTRACT

High Risk African American Teens Fall Short on Asthma Medication Skills

A new study out of Wayne State University points up the need for comprehensive patient education for adolescents with asthma. The research involved 170 African American adolescents who had been hospitalized for asthma at least once over the past year or who had made at least two asthma-related emergency department visits. Using an in-vivo observation asthma skills checklist, observers rated their ability to correctly use their quick relief and controller asthma medications. Correct performance of all of the controller skills was demonstrated by just 5% of the participants and none demonstrated correct performance of all of the quick relief medication administration skills. Attendance at an asthma specialty clinic, collaboration with a provider, medication adherence, and quick relief medication skills predicted the ability to correctly perform all of the controller medication skills. The authors conclude, “Results indicate the need for interventions directly targeting observed asthma management skills and the importance of relationships with providers.” The study was published ahead of print by the Journal of Asthma on April 24. READ ABSTRACT