October 2008

Notes from the Section

• The Fall issue of our section Bulletin is online now and ready for viewing. READ IT HERE
• Check out the ADVANCE PROGRAM to see what’s on tap for adult acute care at this year’s AARC Congress in Anaheim, December 13–16. Here’s just a sampling of the great topics you’ll find: Permissive Atelectasis: Lung Protective or Lung Injurious?; Ride the Wave to Patient Ventilator Interactions; PEEP: Bringing the Evidence to the Bedside; National Asthma Education and Prevention Program (NAEPP) 2007: Differences from Prior Versions; Aerosols in Intensive Care: From Modeling to Management; Assessing and Quantifying Lung Recruitment.
• If you plan to attend the Congress, be sure to make time for our section business meeting, 4:45 p.m.–5:30 p.m., Monday, December 15.

Preventing DVTs Takes Center Stage at Government Agencies
Preventing deep vein thrombosis (DVT) is the goal of a new call to action by the U.S. Surgeon General’s office. The effort is focused on educating the public about DVTs and how to avoid them, and also includes materials for clinicians to use in caring for patients at risk for the condition.

The Agency for Healthcare Research and Quality (AHRQ) has gotten into the act as well, with new DVT guidelines for clinicians and a consumer booklet for patients and families.

View the Surgeon General’s call to action HERE. Read more about AHRQ’s initiatives HERE.

ASV versus PRVCa
Researchers who compared adaptive-support ventilation (ASV) with pressure-regulated volume-controlled ventilation with automode (PRVCa) in patients undergoing cardiac surgery find the median duration of intubation was significantly shorter in the ASV group than in the PRVCa group, with the reduction attributed to a decrease in the duration of mechanical ventilation. The number of arterial blood gas samples taken or manual ventilator setting changes made were similar in the two groups. The study, which was conducted in Hong Kong, involved 48 patients who were randomly assigned to one or the other ventilation strategy. The authors conclude, “ASV is associated with earlier extubation, without an increase in clinician intervention, when compared with PRVCa in patients undergoing uncomplicated cardiac surgery.” The study appeared in the July issue of Anesthesiology. READ ABSTRACT

HFOV Effective for Pulmonary Contusion Patients
A new study out of Duke University Medical Center suggests high frequency oscillatory ventilation (HFOV) used early on in patients suffering from ARDS due to pulmonary contusions leads to rapid improvement in both the oxygenation index and the PaO2/FIO2 ratio. Investigators arrived at these findings after conducting a retrospective chart review of patients at their hospital who received HFOV for severe pulmonary contusions. Seventeen patients met the study criteria and were included in the trial. The research appeared in the August issue of the Journal of Trauma. READ ABSTRACT

Low Tidal Volumes Lead to Stacked Breaths
U.S. researchers who studied breath stacking in patients undergoing mechanical ventilation with low tidal volumes find stacked breaths are a frequent occurrence despite deep sedation, and result in volumes significantly above the set tidal volume. The investigation involved 20 patients who were monitored for a mean of about three days. Results showed:

• Stacked breaths occurred at a mean 2.3 +/- 3.5 per minute and resulted in median volumes of 10.1 (8.8-10.7) mL/kg predicted body weight, which was 1.62 (1.44-1.82) times the set tidal volume.
• Stacked breaths were significantly less common with higher set tidal volumes (relative risk 0.4 for 1 mL/kg predicted body weight increase in tidal volume, 95% CI 0.23-0.90).

The study was published in the September 26 Epub edition of Critical Care Medicine. READ ABSTRACT