September 2007

Congress is Back — We Need to Be Too
Congress is back in session, and that means we all need to redouble our efforts to contact our Senators and Representatives in support of key respiratory legislation, including bills to formally establish pulmonary rehabilitation as a Medicare benefit, repeal Medicare provisions calling for home oxygen patients to assume ownership of their equipment after 36 months, support allied health education, and allow for FDA regulation of tobacco. The AARC is also asking everyone to write their members of Congress, requesting that they support legislation to amend portions of the Part B Medicare law to allow certain respiratory therapists to deliver a broader array of services. You can learn more about these legislative initiatives and how to contact your members of Congress on the AARC’s CAPITOL CONNECTION web site.

Hospitalizations for MRSA Infections Triple
A new report from the federal Agency for Healthcare Research and Quality shows hospitalizations for methicillin-resistant staphylococcus aureus (MRSA) infections more than tripled from 2000 to 2005, accounting for 368,000 stays. Hospitalizations are up ten times from rates noted in 1995. Highlights from the report:

• Average cost for an MRSA hospitalization was $14,000 versus $7,600 for all other stays.
• Average length of stay was 10.0 days versus 4.6 days for all other stays.
• MRSA hospitalizations were more likely to begin in the emergency department, to be transfers from another hospital, or transfers from long-term care settings.
• The in-hospital death rate for MRSA stays was 4.7% compared with 2.1% for non-MRSA stays.
• The MRSA hospitalization rate was three times higher for the elderly than any other age group.
• The most common conditions associated with MRSA are skin infections (18.9% of all MRSA cases), pneumonia (9%), complications of medical care (16%), and septicemia (7.3%).

READ REPORT

Diagnosing and Managing ICU Delirium
Researchers publishing in the August issue of CHEST review the medical literature on ICU delirium, noting the condition affects up to 85% of patients receiving mechanical ventilation and has been linked to prolonged length of stay, reintubation, higher mortality, and higher costs of care. The authors present an evidence-based review for physicians, nurses, respiratory therapists, and pharmacists covering the importance of routinely monitoring patients for delirium and identifying modifiable risk factors for the condition, such as metabolic disturbances and potent sedative and analgesic medications. The authors conclude by noting, “Attention to mitigating risk factors, along with recommended pharmacologic approaches such as antipsychotic medications, may provide resolution of delirium in some patients, while others will persist with refractory brain dysfunction and long-term cognitive impairment following critical illness.” READ ABSTRACT

Results of Roundtable Discussion on HFO Ventilation in Adults
Investigators from five leading academic research centers who took part in a roundtable discussion on high frequency oscillatory (HFO) ventilation in adults provide a protocol they believe may better protect against ventilator-associated lung injury. They conclude HFO may provide smaller tidal volumes and more complete lung recruitment than conventional modes, and recommend optimizing these features by:

• Using the maximum pressure-oscillation amplitude coupled with the highest tolerated frequency, targeting a pH of only 7.25-7.35, to yield a smaller tidal volume than typical HFO settings where frequency is limited to 6 Hz or less and pressure amplitude is submaximal.
• Achieving lung recruitment with the use of recruitment maneuvers, especially during the first several days of HFO.
• Augmenting or sustaining recruitment with generous mean airway pressures chosen either from a table of recommended mean airway pressure and oxygen concentration combinations, or individually titrated based on the oxygenation response of each patient.

The study was published in the July issue of Critical Care Medicine. READ ABSTRACT

Preventing VAP