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American Association for Respiratory Care, Dec. 5-8, 2009

55th International Respiratory Congress

The American Association for Respiratory Care's 55th International Respiratory Congress took place Dec. 5 to 8 in San Antonio, attracting over 5,000 attendees, including respiratory care practitioners, nurses, managers, educators, students, manufacturers and service providers. Participants included both national and international experts. Breakthrough research was presented through concurrent, general, educational and open-forum sessions.

Georgianna Sergakis, Ph.D., of Ohio State University in Columbus, presented data from a clinical study showing that potential fatal and serious complications such as cardiac arrest and respiratory failure may be prevented by employing a specialized rapid response team (e.g., Difficult Airway Response Team [DART]), including a physician, respiratory therapist (RT) and registered nurse. In this study, the researchers performed a retrospective chart review of patients at a metropolitan level-one trauma center implementing DART to evaluate and stabilize patients with difficult airways.

The study found that DART protocol implementation reduced the total number of intubation attempts, cricothyroidotomies and tracheostomies, with 56 percent of patients surviving to discharge.

"The innovative utilization of the DART has improved overall patient safety and the quality of care to patients with difficult airways in a level-one trauma center," the authors concluded. "RTs believe they play an integral role and are valuable to the team's success."

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Howard Stein, M.D., of Toledo Children's Hospital in Ohio, shared research findings that showed Neurally Adjusted Ventilatory Assist (NAVA) is equally effective as conventional ventilation (CV) using Spontaneous Intermittent Mandatory Ventilation/Pressure Control (SIMV/PC) with Pressure Support (PS) in ventilating neonates. The study evaluated blood gases of 87 neonates, initially ventilated with CV and converted to NAVA, ranging from 22 to 40 weeks' gestation from May 2008 until May 2009.

The study showed that conversion from CV to NAVA improved blood gases, with over- and under-ventilated neonates able to significantly correct their pH and carbon dioxide levels to within normal range.

"We conclude that neonates have the capacity to ventilate better on NAVA as compared to CV. The neonatal brainstem appears sufficiently mature enough to regulate ventilation effectively on NAVA," the authors stated.

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Howard Stein, M.D., also presented results from another clinical study showing that NAVA is equally safe as CV using SIMV/PC with PS in ventilating neonates. The study found no statistically significant incidence differences of intraventricular hemorrhage (IVH), pneumothorax, or Necrotizing Enterocolitis or spontaneous perforation (NEC/perf) between neonates less than 31 weeks' gestation or weighing fewer than 1500 grams at birth and all neonates ventilated on NAVA from May 2008 to May 2009.

"We conclude that NAVA does not increase the risk of IVH, pneumothoracies or NEC/perf in neonates <1500 grams birth weight or <31 weeks' gestation compared to SIMV/PC with PS," the authors stated.

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Patricia DeJuilio, a registered RT (with Neonatal/Pediatric Specialist designation), of Central DuPage Hospital in Winfield, Ill., presented data that showed implementation of a ventilator-associated pneumonia (VAP) prevention protocol, including oral care and multidisciplinary change-management, improved compliance and reduced associated costs. As compliance with an oral care and Institution for Healthcare Improvement ventilator bundle protocol increased, VAP decreased, with rates dropping to zero over time.

"Multidisciplinary change-management is essential to ensure compliance with a ventilator bundle and oral care protocol and prevention of VAP," the authors concluded.

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Brian W. Carlin, M.D., of Allegheny General Hospital in Pittsburgh, presented findings showing Inspired Technologies' SmartDose device with a Clinical Oxygen Dose Recorder (CODR) to be more effective than other standard oxygen delivery devices at providing adequate dose delivery and oxygen saturation during exercise. In this study, nine patients were evaluated after a six minute walk using their prescribed oxygen dose, and then again using the SmartDose device with CODR after a 10 minute rest.

The study found that the SmartDose device with CODR allowed all patients to complete testing, while three patients were unable to complete testing with standard devices. The SmartDose device also allowed for lower titrated oxygen doses and higher Pulse Oximeter Oxygen Saturation levels.

"The SmartDose device improved oxygen saturation, in some cases with lower settings, as well as walk duration in patients undergoing rehabilitation," the authors concluded.

The study was funded by Inspired Technologies.

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Edmond Toy, Ph.D., of the Analysis Group in Boston, shared research findings that show less frequent dosing in chronic obstructive pulmonary disease (COPD) patients promotes better patient compliance, therefore reducing the use of health care resources and associated costs. The study used a health insurance claims database to evaluate daily dosing frequency, proportion of days covered, inpatient days, and medical visits. In addition, 2005 Medical Expenditure Panel Survey data and medical Consumer Price Index data were used to extrapolate to 2008 unit health care costs.

In a statement, Toy said "Our study of the real-world experience of 55,000 COPD patients shows that patients prescribed maintenance therapies that are taken fewer times per day (e.g., once per day rather than four times per day) are more likely to use the medicine consistently; that is, they have higher 'compliance' levels. In addition, our analysis shows that higher compliance levels are associated with better health outcomes."

The study was funded by Novartis Pharmaceuticals Corporation.

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Mathew Pavlichko, a registered RT (with Neonatal/Pediatric Specialist designation), of The Reading Hospital and Medical Center in Pennsylvania, presented data that demonstrated the use of a high flow nasal cannula (HFNC) to be effective and safe in neonates in the intensive care unit. In this study, 69 infants were evaluated over a nine-month period, covering 10,000 hours of HFNC therapy. The study included 41 neonates with progressive weaning from ventilator assistance or nasal continuous positive airway pressure to bubble humidifier nasal cannula; 26 neonates with increased apneas, desaturations, or work of breathing; and two neonates with evidence of pneumothorax requiring less invasive support.

"This study demonstrated that high flow rate, heated, humidified nasal cannula is a well-tolerated, safe, and effective adjunct therapy," the authors stated.

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Daria Donelly, a registered RT, of Children's Hospital Boston, shared research findings from a bench mark study showing that Maquet's Servo-i with heliox capabilities provided improved gas blending capabilities as compared to Cardinal Health's Viasys Avea. Overall, Servo-i used less helium (approximately 893 liters of helium per hour), reducing costs by $203 per day.

"If less heliox is consumed there will be less of a need to store and transport multiple tanks leading to labor cost reduction associated with the therapy. In addition, proper utilization of helium may add to the flexibility of the clinician," the authors concluded.

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