June 2013
Nominate a Peer for Specialty Practitioner of the Year
The deadline for nominating a fellow section member for our 2013 Specialty Practitioner of the Year Award is July 31, so start brainstorming worthy candidates and then nominate them using the nomination form on our SECTION WEBSITE.
Prenatal Exposure to Major Roadway Ups Risk for Respiratory Infections by Age Three
Pregnant women who live near a major roadway are more likely to have children with an increased risk of respiratory infection by age three. That’s the take home message from Boston researchers who presented their findings at the ATS 2013 International Conference. The study included 1271 mother-child pairs enrolled during the first trimester of pregnancy between 1999 and 2002 in Project Viva in eastern Massachusetts. Among this group, 6.4% lived less than 100 meters from a major roadway, 6.5% lived 100 to 200 meters, 33.7% lived 200 to less than 1000 meters, and 53.4% lived 1000 meters or more. By the age of three 678 (53.3%) of the children had had at least one doctor-diagnosed respiratory infection. After adjustment for possible confounders and risk factors for respiratory infection, children whose mothers lived less than 100 meters from a major roadway during pregnancy were 1.74 times as likely as those living 100 meters or more to have had a respiratory infection. READ PRESS RELEASE
HHFNC System Found Lacking for Albuterol Administration
U.S. researchers publishing ahead of print in Pediatric Critical Care Medicine on April 26 report poor results for the delivery of albuterol by a vibrating mesh nebulizer through a humidified high-flow nasal cannula system. The study took place in an aerosol research laboratory and measurements were made using varying flow rates through infant, pediatric, and adult nasal cannulae. Among the findings:
- The inspired dose (percent of nominal dose) for each cannula size and flow rate was 2.5%, 0.8%, 0.4%, and 0.2% for the adult cannula at 5, 10, 20, and 40 L/min, respectively; 1.2%, 0.6%, 0.1%, and 0.0% for the pediatric cannula at 3, 5, 10, and 20 L/min, respectively; and 0.6%, 0.6%, and 0.5% for the infant cannula at 3, 5, and 8 L/min, respectively.
- 62-80% of the loaded albuterol dose accumulated within the adaptor.
- For each cannula size, there was a significant decrease in the inspired dose with increasing flow rates, p = 0.026 (infant), p = 0.001 (pediatric), and p < 0.001(adult).
- The inspired dose increased with increasing cannula size for 5, 10, and 20 L/min (p = 0.007, p < 0.001, and p = 0.005, respectively).
- The mass median aerodynamic diameter for all trials was less than 5 µm.
The authors conclude that more study is needed before aerosolized albuterol is routinely delivered through a high-flow system. READ ABSTRACT
Editor’s Note: The AARC has developed an IRB RESEARCH PROTOCOL to help RTs get more involved in conducting studies on heated high flow nasal cannulas.
Artificial Placenta, Revisited
Invasive and noninvasive ventilation can go a long way in treating respiratory insufficiency in preterm infants, particularly those born with very low birth weights. But they have their limits. Canadian investigators publishing ahead of print in the International Journal of Artificial Organs on May 6 review past and present work on the development of an “artificial placenta” to provide respiratory support in cases where conventional methods fail. The authors note that the first attempt at such a device took place more than 60 years ago, but the concept is being revisited today with development of major components such as the oxygenator, vascular access via umbilical vessels, flow control, and methods to achieve hemocompatibility in extracorporeal circuits. READ ABSTRACT
Language Barrier May Explain Increased Health Care Utilization for Latino Infants
A language barrier may explain why Latino infants making an unscheduled health visit for an acute respiratory illness underwent more testing and were prescribed more antibiotics than other children in a study conducted by researchers from Vanderbilt University. The investigators looked at 674 term-born, previously healthy infants. Among the group 52% were white, 22% were African-American, 14% were Hispanic, and 12% were of another race or ethnicity. While the bronchiolitis severity score was higher in white infants than Latino infants, and disease severity was about the same for Latino and African-American infants, Latino infants were more likely to receive antibiotics and to have body fluid cultures drawn than either whites or African-Americans. Chest radiography and respiratory virus rapid antigen testing were more common in Latinos than African-Americans as well. Latino infants from Spanish speaking families were more likely to be tested for the respiratory syncytial virus than those from families that spoke English. The study was published ahead of print by the Journal of Pediatrics on May 23. READ ABSTRACT
