January 2009

Notes from the Section

  • The section would like to congratulate Jackie Brenchley, RRT, CPFT, AE-C, on being named Diagnostics Specialty Practitioner of the Year for 2008. (You can read much more about Jackie in the Winter Bulletin.)

FENO Found Lacking in the ED
U.S. researchers who studied the use of fractional excretion of nitric oxide (FENO) measurements in children seeking emergency department care for an acute exacerbation of asthma found little benefit to the measure. Noting FENO has been used as a noninvasive marker for the assessment and management of asthma in both adults and children, they used a tidal breathing method of real-time display to measure FENO concentrations before and one hour after administration of corticosteroids in children ages 2-18 who visited their EDs, and again at discharge. Adequate breaths for FENO measurement were achieved by 68% of the 133 children in the study. Results showed:

  • No difference in the median initial FENO concentration among subjects, regardless of the severity of their acute asthma.
  • No change in FENO concentrations from the start to the end of treatment in most patients.
  • No significant association between FENO concentrations and other short-term outcomes.

The authors conclude FENO has limited utility in the ED management of children with acute asthma. The study appeared in the November 27 Epub edition of Academic Emergency Medicine. READ ABSTRACT

New Test May Assist with Interventional Bronchoscopy Outcome Assessment
A new study out of Germany suggests vibration response imaging (VRI) may be useful as an adjunct to interventional bronchoscopy. Researchers conducted the test, which is used for breathing sound mapping, in 83 patients with suspected central airway stenosis and 25 healthy volunteers. The investigators found a 95% agreement between raters and clinical assessment in distinguishing between normal and abnormal images. Sensitivity and specificity were 97% and 88%, respectively; and the test was 85% accurate in locating tracheal obstruction and 88% accurate in locating bronchial obstruction, compared to bronchoscopy. Overall accuracy was 83%. VRI correctly detected the affected side in bronchial obstructions in 88% of cases, and the overall accuracy of VRI in defining the outcome of interventional bronchoscopy was 84%. The researchers believe these findings show VRI has the potential to become a valuable complementary tool in evaluating treatment outcome in patients with central airway obstruction. They published their results in the December 9 Epub edition of Respiration. READ ABSTRACT

AARC Member Coauthors Review in CHEST
AARC member Susan Blonshine, RRT, RPFT, FAARC, joins a physician colleague in providing an overview of respiratory airflow resistance measurements in the December issue of CHEST, noting these tests provide an effort-independent measure of airway status and allow assessment of patients who are unwilling or unable to perform spirometry. She and her co-author go on to cover the various methods used to conduct the tests, including esophageal balloon and airflow perturbation techniques, emphasizing that the latter are becoming more widely used. Body plethysmography remains the gold standard, however, although the equipment is expensive and the operator must be highly trained to achieve valid results. Reimbursement for these tests varies depending on regional guidelines. READ ABSTRACT

Preoperative Smoking Status Doesn’t Impact Post-Surgery PFTs, Complications
Delaying surgery for non-small cell lung cancer (NSCLC) due to the failure of the patient to stop smoking is unnecessary, report University of Minnesota researchers publishing in the November 17 Epub edition of Lung Cancer. They studied patients who underwent surgical resection between 2000 and 2006, dividing the group into distant smokers (quit more than a month before surgery), recent smokers (quit within a month of surgery), and current smokers (failed to quit prior to surgery). No differences in FEV1 were seen between the three groups, and complication rates after surgery were about the same. “Smoking cessation immediately before NSCLC resection does not significantly impact postoperative pulmonary complication rates or 1-year postoperative PFT results and therefore should not be a reason to delay surgical resection,” write the authors. READ ABSTRACT


 

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