4th Annual Canadian PFT Symposium is only 30 days away

September 13-14, 2019, Ottawa On

The Canadian PFT Symposium is co-sponsored by the CACPT and Novus Medical Int. This year’s Canadian PFT Symposium boasts an all star line up of PFT experts. Attendees will receive education on the various components pulmonary function testing. The educational offering has been approved for 12 continuing educational/professional development credits by the CSRT and the CACPT.

Don’t miss this opportunity.

Spots are still available but selling out fast. Don’t delay and go to www.CACPT.ca to sign up or for more information.

New Distribution Announcement for the LiteAire Spacer

Novus Medical Inc. has signed a new distribution agreement with Thayer Medical to provide the LiteAire® spacer. This announcement coincided with the 2019 CSRT conference where Novus Medical and Thayer Medical jointly displayed the Thayer Medical products in the Novus Medical exhibit booth.

The LiteAire® spacer is a collapsible MDI holding chamber that features a dual valve system, stores flat, pup up to use, portable, single patient use and is compatible with the commonly prescribed MDI’s.

Thayer also produces the Thayer Valved Tee Adapters and MDI adapters, making it simple to provide nebulized treatments or MDI dosages directly into the ventilator circuit.

Thayer is also know for the Quake Airway Clearance Device. The Quake is an innovative and unique device that provides mucus clearance therapy in a portable easy to use, handheld device.

For more information or to order your Thayer products, email info@novusmedical.ca.

UPDATE: Novus Medical's Thoracic Park, Opening Friday May 10 at 9pm til close.

Novus Medical Inc. will be re-opening Thoracic Park again at the upcoming CSRT Conference, to be held this year in Niagara Falls, from May 9 to 11. Thoracic Park will open its doors at 9pm on Friday evening, May 10th, at the Hard Rock Cafe nightclub, located across the hall from the Hard Rock Cafe restaurant, next to the conference centre. Thoracic Park T-shirts will be making their return by popular demand. Come to the park to get your’s.

Novus Medical is a Platinum Sponsor of the CSRT Annual Education Conference and is also the sponsor for the Saturday nights post banquet entertainment. You won’t want to miss this event.

Come to the Novus Medical exhibit to see the latest in Respiratory Therapy Technology and to learn more details about Thoracic Park.

Novus Medical's Thoracic Park, Opening Soon

Novus Medical Inc. will be re-opening Thoracic Park again at the upcoming CSRT Conference, to be held this year in Niagara Falls, from May 9 to 11.

Novus Medical is a Platinum Sponsor of the CSRT Annual Education Conference.

Come to the Novus Medical exhibit to see the latest in Respiratory Therapy Technology and to learn more details about Thoracic Park.

Looking for a KOKO Spirometer?

Have you been looking to purchase a KOKO spirometer? The Canadian market has embraced the CPFS/D spirometer as the new replacement for the KOKO spirometer. The CPFS/D, may not be as easy to say as KOKO, however it is fully licensed by Health Canada, and boasts PFT lab quality spirometry testing on Windows 7 and 10 environments on a desktop, laptop and Windows® tablets.

The CPFSD is perfect for Hospitals, RT departments, physician offices, community health clinics, asthma clinics, COPD clinics, and occupational health departments. Contact us now to have a sales representative in your area set up a demonstration or provide you with a quotation.

Novus Medical also provides Canada’s number 1 selling pulmonary filter to keep your patients and equipment clean and safe. We also supply nose clips and calibration syringe exchange program.

Novus Medical has 30 years of experience selling and servicing pulmonary diagnostics and will be there to service and train you in the use of your new spirometer. Novus Medical, Excellence through Experience.

Spirometry Certification

The Canadian Association of Cardio-Pulmonary Technologist (CACPT) is a not-for-profit organization which provides an examination platform, the National Registry Examination, for technologists who are working in the fields of Pulmonary and Cardiovascular technology.  The National Registry Examination tests the candidate on all aspects of Pulmonary Function Testing and Cardiovascular Technology.  While the CACPT is an unregulated body, candidates who successfully challenge the National Registry Examination are recognized nationally as having the skill, knowledge and ability to provide health care workers with accurate and comprehensive information on lung function and cardiovascular anatomy, health and function.

In addition to the National Registry Examination the CACPT, in collaboration with the Canadian Board of Respiratory Care (CBRC), will now provide Spirometry Certification.

Why Certification?

·    Spirometry is the most reliable way to help diagnose lung disease and assess disease progression and response to treatments.

·    Poorly performed spirometry greatly increases the risk of misinterpretation of results, mis-diagnosis and incorrect treatment

 ·    Spirometry Certification provides an objective assessment of knowledge and competency for individuals who have completed a spirometry training course and maintain competency at 3 year intervals

 Spirometry Certification can lead to:  

·    Greater confidence in results

·    Higher quality of testing

·    Increased number of successful tests

·    Improved understanding of the impact of testing procedures; choice of predicted values; formatting of results 

·    Robust knowledge of Quality Control requirements and procedures

·    Improvements in patient care

 Who can apply:

The Spirometry Certification is intended to improve the quality of Spirometry testing, not only for those preforming Spirometry Testing in a hospital setting, but in any other facility such as doctors’ offices, family health teams  and research labs. 


Exam date: September 30 2019                 Application deadline: June 20 2019

Information and Applications:

For more information or to submit applications visit CACPT.ca

All questions and comments should be directed to spirometry@cacpt.ca

Novus Medical Now Sells Home Ventilators

Novus Medical now represents the Löwenstein Medical prisma VENT series of home care ventilators. The prisma VENT series is a German engineered home care ventilator built with the high quality that Canadians have come to expect from German made products. The prisma VENT is designed to be easy to use and maintain. With a minimal 12 hour battery specification, the device is a favourite for home ventilated clients who want to get out of the home or simply have that confidence that the ventilator will continue to function during power outages. For those patients that like or need to travel, the prisma VENT is certified for air travel. In other words, the prisma VENT home ventilator can be used by clients taking commercial flights. The prisma VENT series can be configured for mouth piece ventilation, incorporates synchronizations tools, leak valve or exhalation valve circuits and user interface that is simply, easy to use.

“This is the latest technology for home ventilation to hit the Canadian market”, said Robert Simms, Business Manager for Novus Medical. “The features, performance, price and minimal maintenance was enough to convince us that partnering with Löwenstein Medical and their prisma VENT series of home care ventilation was the right move for Novus Medical and for Canadian home ventilation patients” .

Novus Medical Inc. is a leading Canadian Medical distributor of Respiratory Therapy and Pulmonary Diagnostic products, based out of Oakville, ON. Novus Medical puts a strong emphasis on importing and distributing high quality medical devices, manufactured by companies with exemplary customer service. For more innovative respiratory technology, visit www.novusmedical.ca

Löwenstein Medical GmbH & Co. KG, Germany is specialised in development, production and sales of medical devices and systems. For almost 30 years of company history, Löwenstein Medical have made an important contribution to patient care. In neonatal care, intensive care ventilation and anaesthetics the company develops and manufactures its own innovative products which are used worldwide. With its intensive research and development work, Löwenstein Medical always succeed in producing new products for the market, hence making a significant contribution to medical progress. Building on a first-class workforce, a well-established sales infrastructure and a company strategy which constantly aims to benefit the user, Löwenstein Medical will continue to produce and sell high-quality state of the art medical devices and systems, with the main focus being on patient care. With more than 1500 employees and 150 branches throughout Germany, Löwenstein Medical ensure high quality products.

Holiday Hours

Novus Medical will be closed on the following days during the Christmas Holidays.

Dec 24, 25, 26

Dec 31 and Jan 1, 2019.

Happy Holidays and a safe and prosperous New Year from all of us at Novus Medical Inc.

Asthma.ca Speaker Series Webinars - Proper Diagnosis and Correct Testing

Proper Diagnosis and Correct Testing

A recent study led by Dr. Shawn Aaron shows that over 30% of Canadians may have been incorrectly diagnosed with asthma. While some patients may have experienced a remission since their diagnosis, there are concerns in both the scientific and patient communities that asthma diagnoses are often made without proper testing. Likewise, a significant percentage of Canadians also live with undiagnosed asthma.

Dr. Shawn Aaron led a team of researchers to investigate this issue. Don’t miss the opportunity to hear Dr. Aaron address the issue of misdiagnosis of asthma in Canada and offer advice about the steps you can take to ensure a correct diagnosis from your healthcare provider. 

After the presentation, you will have the opportunity to ask your most pressing questions to our guest speaker, Dr. Shawn AaronMD, FRCPC, a respirologist with special research and clinical interests in asthma, COPD, and cystic fibrosis. Dr. Aaron has many significant achievements in asthma-related research over the course of his distinguished career, and was presented with the 2017 Asthma Canada Lead Investigator Award for his research in the misdiagnosis of asthma and the prevalence and economic/health burden of undiagnosed airflow obstruction in Canadian communities

What You’ll Take away From Dr. Aaron’s Talk: 

  • Common reasons for the misdiagnosis of asthma in Canada.

  • What can be done to address the issue of misdiagnosis?

  • How should asthma be assessed and diagnosed?

  • What you can do to ensure a correct diagnosis from your healthcare provider?

Register for our FREE webinar by going to https://asthma.ca/event/speaker-series-proper-diagnosis-and-correct-testing/

MGC Cardiorespiratory Diagnostics Seminar, Spring Series 2019. Orland FLA

Join us in Orlando Florida, March 4-6, 2019 for the Spring Series of the MGC Cardiorespiratory Diagnostics Seminar. Led by experts in the field of cardiorespiratory testing, the seminar for any healthcare professional who performs or interprets spirometry, PFT and CPET. Learn about quality assurance, the current ATS guideline, and techniques. It is a great opportunity to network with your peers from across North America as well as the faculty.

Canadian Pulmonary Function Symposium

Canadian Pulmonary Function Symposium

Presented by the CACPT in Partnership with Novus Medical Inc. and MGC Diagnostics.  September 21-22, 2018, Calgary AB, Coast Plaza Hotel and Conference Centre, 1316 33rd St. Northeast, Calgary AB.  Rates starting at $119.00 per night.  1-800-661-1464 or email at res@calgaryplaza.com

Early bird registration before July 31st, 2018, $300+21.94 fee.  Includes Friday Sept. 21st evening social event.  

General Registration $350+25. fee after July 31st.  

Please find attached, the course agenda.  We hope to see you there. 

PFT Seminar Brochure Final_2018.jpg
PFT Seminar Brochure 2 Final_2018.jpg

2018 CSRT Educational Conference and Exhibition

The 2018 CSRT Education Conference and Exhibition will be held May 24-26 in Vancouver, BC.  Novus Medical will be attending as a conference sponsor.  If you are attending the conference this year, come by the Novus Medical and the MGC Diagnostics booth to view our latest in Pulmonary diagnostics technology the Resmon FOT and the latest in Critical Care ventilation in Canada, the IMT Medical Bellavista.  

Novus Medical Inc. will also be displaying the Inspire nCPAP generator the direct replacement for the Infant Flow generator now that it is no longer available in Canada.  The Inspire nCPAP generator has been validated by the original inventors and manufacturers of the EME Infant Flow and uses the same bonnets, masks and prongs as Infant Flow, allowing you to use up your existing stock.  

Looking for a replacement for your Microgard pulmonary function filter?  Come by the Novus Medical booth to see the Neumofilt pulmonary filter, a direct replacement for the Microgard filter. Novus Medical moves over 30,000 of these filters out of Novus warehouse, each month.  A quality filter at a great price and unparalleled customer service is a winning combination.  


Source: https://conference.csrt.com

Role of diaphragmatic rapid shallow breathing index in predicting weaning outcome in patients with acute exacerbation of COPD

Role of diaphragmatic rapid shallow breathing index in predicting weaning outcome in patients with acute exacerbation of COPDRole of diaphragmatic rapid shallow breathing index in predicting weaning outcome in patients with acute exacerbation of COPD

Ahmad Abbas, Sameh Embarak, Mohammad Walaa, Samah Mohamed Lutfy

Chest Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt

Background: The diaphragmatic rapid shallow breathing index (D-RSBI), which is the ratio between respiratory rate (RR) and the ultrasonographic evaluation of diaphragmatic displacement (DD), is a new and promising tool to predict weaning outcome. Its accuracy in predicting weaning failure, in ready-to-wean acute exacerbation COPD (AECOPD) patients, needs to be evaluated.
Patients and methods: A prospective observational study was carried out on ready-to-wean AECOPD patients. During a T-tube spontaneous breathing trial (SBT) evaluation of the right hemidiaphragm displacement (ie, DD), M-mode ultrasonography to calculate the D-RSBI, as well as the RSBI (RR/tidal volume [VT]) were carried out simultaneously. Outcome of the weaning trial was recorded. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic accuracy of D-RSBI and RSBI.
Results: A total of 50 AECOPD patients requiring mechanical ventilation for more than 48 h who were ready to perform a SBT were included. Of these, 37 (74%) were successfully liberated from mechanical ventilation. Among the 13 patients who failed the weaning trial, 8 (62%) failed the SBT and reconnected to the ventilator, 2 (15%) were reintubated within 48 h of extubation and 3 (23%) required NIV support within 48 h of extubation. The areas under the ROC curves for D-RSBI and RSBI were 0.97 (p<0.001) and 0.67 (p<0.06), respectively.
Conclusion: D-RSBI (RR/DD) is superior to the traditional RSBI (RR/VT) in predicting weaning outcome in AECOPD patients.

Keywords: rapid shallow breathing, diaphragmatic displacement, ultrasonography, spontaneous breathing trial, weaning

Source: https://www.dovepress.com/role-of-diaphrag...

Save the date for the Cardiorespiratory Diagnostics Seminar

Register early to guarantee your place at the 2018 Cardiorespiratory Diagnostics Seminar.  The 2018 Seminar will be held at the New York-New York Hotel and Casino, Las Vegas, Nevada, on October 22-24, 2018.  

The seminar include lectures, hands-on demonstration workshops, and group discussions, led by the Cardiorespiratory diagnostic luminaries.  

for more information visit www.mgcdiagnostics.com/events

IMT Medical releases the bellavista MR

bellavista 1000 mr

Because continuity counts.

Highly sophisticated intensive care ventilation for your patients in an MRI environment.

With the bellavista 1000 mr, you can now continue your lung-protective ventilation strategy for your patients without any limitations in an MRI environment. During the time spent in the MRI scanner additional safety is provided by the magnetic field strength indicator of the MR-Guard module. The bellavista 1000 mr can be used for universal applications ranging from neonatal to adult ventilation, regardless of whether you wish to ventilate invasively or non-invasively or whether you want to administer High Flow Oxygen Therapy.

Our high-performance turbine drive, compact design and a battery time of at least four hours give you a wide scope of action for your in-hospital transfers.


Feeding in the PICU Is a Balancing Act

Honolulu—Feeding patients in the pediatric ICU (PICU) requires a delicate balance between minimizing protein catabolism and meeting energy requirements, according to presentations at the 2017 annual meeting of the Society of Critical Care Medicine.

“Globally, about a third of patients being admitted to the pediatric intensive care unit have preexisting malnutrition,” said Katri V. Typpo, MD, MPH, an associate professor at the University of Arizona College of Medicine, in Tucson. “And up to 66% or more have acquired malnutrition at the time of PICU discharge.”

There are several causes of this malnutrition. “Our children in the PICU have minimal substrate reserves,” Dr. Typpo said during her presentation. “They have an altered metabolism. They have inadequate nutrient delivery much of the time. And they [may] have chronic diseases that may impact their malnutrition at the time of admission.”

Michael L. Christensen, PharmD

Providing adequate nutrition in this population is critical to outcomes. “Nutrition is a little like Goldilocks—too much or too little and your patient suffers with a negative clinical consequence; but if you get it just right, then maybe our patients will do well,” Dr. Typpo said.

Under- and overfeeding critically ill children have “been associated with poor outcomes in these patients,” said Michael L. Christensen, PharmD, a professor in the Departments of Clinical Pharmacy and Pediatrics at the University of Tennessee Health Science Center, in Memphis, who was asked to comment on the topic but did not present at SCCM. He cited, as an example, a study showing that hyperglycemia led to longer duration of ventilator use in 37 premature infants with sepsis (J Pediatr Surg 2006;41[1]:239-244). The study also found that the maximum serum glucose concentration after a positive blood culture was linked to duration of total parenteral nutrition (PN) (R=0.45; P=0.005), duration of mechanical ventilation use (R=0.45; P=0.006) and length of stay (R=0.36; P=0.005).

Another study (Crit Care Med 2012;40[7]:2204-2211) found that in 500 mechanically ventilated children, patients receiving PN had higher mortality rates than those receiving enteral nutrition (EN) (odds ratio [OR], 2.61; 95% CI, 1.3-5.3; P=0.008).

Predicting Energy Expenditure

Dr. Typpo cited another challenge in optimizing nutrition in the PICU: the standard formulas used to predict energy expenditure, such as the Harris-Benedict equation, the Caldwell-Kennedy and the WHO resting energy expenditure equation, can under- or overestimate calorie needs by as much as 20%. In a study that compared several of these predictive equations, none of them accurately estimated energy needs. In fact, the Harris-Benedict equation underestimated resting energy expenditure by a mean of about 150 kcal per day (J Crit Care 2012;27[3]:321.e5-321.e12), she noted.

Indirect calorimetry may provide a more accurate measurement of energy expenditure. “But a lot of hospitals don’t have that capability or expertise,” Dr. Christensen said. “What we’re often left with is giving our best estimate and then frequently reassessing the patient to see if, in fact, we are meeting their [nutritional] needs,” he said.

Protein is critical to delivering sufficient nutrition and may influence outcomes, specifically reducing the probability of death. “There’s a lot of emerging data to suggest that protein delivery is extremely important in improving patient outcomes,” Dr. Typpo said.

For example, a study found that in mechanically ventilated children, delivery of more than 60% of prescribed protein intake is linked to a 3.2% risk for 60-day mortality compared with a 9.3% risk in patients who received less than 20% of prescribed protein (Am J Clin Nutr 2015;102:199-206).

How, When and Where to Feed

When to initiate EN has been controversial, noted Sharon Y. Irving, PhD, RN, an assistant professor of pediatric nursing at the University of Pennsylvania, in Philadelphia. “We know that early enteral nutrition is a positive in this population,” Dr. Irving said during the SCCM annual meeting. That observation supported by published research. For example, a multicenter, retrospective study of 5,105 patients in 12 PICUs showed that early EN, started within 48 hours of PICU admission, is linked to decreased mortality (J Parenter Enteral Nutr 2014;38[4]:459-466). Patients who received early EN had a lower mortality rate than those without early EN (OR, 0.51; 95% CI, 0.34-0.76; P=0.001).

Gastric Feeding Preferred

Enteral feeding can be delivered through gastric or post-pyloric tubes. A study found that feeding via the small bowel achieved 47±22% of the daily caloric goal compared with 30±23% for gastric feeding (P<0.01) (Chest 2004;126[3]:872-878). However, gastric feeding may be more physiologic and better tolerated overall.

Dr. Christensen cited another advantage of gastric tube feeding: “If the tube is placed far enough into the small intestine, you are less likely to get vomiting or aspiration of the contents,” he said.

There is a place for PN, however, such as when the patient has severe gut ischemia, an acute surgical abdomen or intraabdominal hypertension, according to Dr. Irving.

For infants, the question of when to use PN feedings depends on the patient’s nutritional status, gastrointestinal function and tolerance, Dr. Christensen pointed out. A critically ill infant would be started on PN within two to three days of PICU admission if enteral feeding is inadequate or not feasible. For premature infants with an uncertain GI tract, PN would be started as soon after birth as possible to prevent the infant from going into a catabolic state. “We try to get protein into premature infants as quickly as possible,” he said.

Colleen Owens

Dr. Irving reported no relevant financial disclosures. Dr. Typpo reported partial funding for an investigator-initiated clinical trial from Baxter, and has received an NIH NIDDK K23 grant. Dr. Christensen reported membership on the data safety monitoring board for Fresenius Kabi.

Source: http://www.anesthesiologynews.com/Web-Only...

Cardinal Health Canada no longer representing VMAX PFT from Vyaire Medical

Cardinal Health Canada is no longer the Canadian representative for Vyaire Medical and it's products including the VMax pulmonary function (PFT) system.  The unannounced change in representation, effective July 1, 2017, has left VMax PFT users on their own with no sales or clinical application specialists to support the products.  Service support for parts and maintenance may also be affected. Neither Cardinal Health Canada nor Vyaire Medical have provided an announcement on their website or by official announcement letter concerning the disruption in business.  Canadian VMax users have simply been left hanging with no communication what so ever.  

Novus Medical Inc. has received several calls to inquire if Novus can do service on the VMAX PFT systems.  Unfortunately, as Novus Medical Inc. is not the Canadian representative for Vyaire Medical, we are unable to provide that service.  Novus Medical Inc. will be able to provide an alternative to the VMax PFT systems with the two lines of PFT that we do represent, MGC Diagnostics and Morgan Scientific.  Should any VMax users wish to replace their PFT system with new equipment,  Novus Medical Inc. will be there to support you with all of the honesty, integrity and professionalism that you have come to expect from Novus Medical Inc.  Novus Medical is large enough to support you and small enough to care.  We know our customers by name, not account number.  

Please contact info@novusmedical.ca for all of your PFT and CPET needs.  


Study reveals safety of patient-administered sedatives during mechanical ventilation

July 3, 2017

New research takes a novel approach to traditional, clinician-only sedative delivery, finding that select critically ill patients can safely self-administer sedatives to manage their anxiety during mechanical ventilation.

Patients in intensive care units (ICUs) are often lightly sedated to promote their comfort with mechanical ventilator breaths and to reduce anxiety. Clinicians use subjective assessment and observation of the patient to administer medications, and the resulting sedative delivery may be inconsistent across providers and not congruent with individual patient needs.

"Safety and Acceptability of Patient-Administered Sedatives During Mechanical Ventilation" is published in the July 2017 issue of American Journal of Critical Care (AJCC).

Leading the study was Linda Chlan, RN, PhD, professor of nursing and associate dean for nursing research at Mayo Clinic, Rochester, Minnesota, whose research on patient-centered symptom management interventions spans more than 20 years.

Other members of the research team included Debra Skaar, PharmD; Mary Fran Tracy, RN, PhD, CCNS; Kay Savik, MS; and Craig Weinert, MD, MPH, all associated with the University of Minnesota. Other authors are Sarah Hayes, PharmD, pharmacy resident at North Memorial Medical Center in Minneapolis, and Breanna Hetland, RN, PhD, CCRN-K, postdoctoral fellow at the Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland.

"How best to manage the many symptoms experienced by patients undergoing mechanical ventilation without contributing to adverse ICU-acquired conditions remains a daunting challenge for clinicians," Chlan said. "Addressing these complex issues requires innovative approaches and challenging the usual way of managing critically ill patients. By appropriately empowering patients to self-manage their symptoms, we can help meet their highly individualized needs for sedative therapy to promote comfort."

This study builds upon prior research that found patients receiving mechanical ventilation were willing, able and satisfied with their ability to self-administer sedative medication to manage their anxiety.

During the pilot trial in three ICUs in Minnesota, 17 intubated patients were randomly assigned to self-administer dexmedetomidine, which provides light sedation, and 20 patients were allocated to receive usual care, continuing their current sedative regimen. Only patients receiving mechanical ventilation who were willing and able to self-manage sedative therapy were eligible for the study.

Patients who self-administered dexmedetomidine were instructed to depress the push button when they felt anxious or if they desired medication for relaxation. They were allowed up to three self-administered boluses of the sedative therapy per hour, with a 20-minute lockout. Bedside nurses also adjusted the basal infusion rate, according to the patients' bolus attempts in the preceding two hours.

Overall, findings indicate that dexmedetomidine is safe, using pre-defined criteria, for a select sample of patients during the later, more stable part of mechanical ventilation. Changes in heart rate and mild hypotension during the infusion were comparable to those noted with clinician-administered sedatives. No self-extubations occurred in patients randomized to the dexmedetomidine group.

A follow-up survey also found that a majority of patients in the experimental group were satisfied with their ability to self-administer sedative therapy to control anxiety and achieve relaxation. Their ability to manage anxiety was comparable to that of patients who received clinician-administered medication.

Interestingly, no patients in the dexmedetomidine group experienced delirium after enrollment, whereas four patients in the usual care group did. The researchers recommend further exploration in larger studies to determine whether patient-controlled sedation can achieve clinically relevant outcomes, such as shorter duration of mechanical ventilation, prevention of delirium and improved recovery after critical illness.



Applying continuous airway pressure improves respiratory and survival rates in children

An interesting article about the use of NIV and CPAP for respiratory distress in children.  The IMT Medical Bellavista ventilator is designed to deliver NIV and CPAP to all age groups, from neonates, to paediatrics to adults.  



Applying continuous airway pressure improves respiratory and survival rates in children



June 20, 2017 -- A study by researchers at Columbia University Medical Center and the Mailman School of Public Health found that applying continuous positive airway pressure (CPAP), a form of non-invasive ventilation, decreased mortality in children with respiratory distress. Findings from the trial in Ghana indicated that the procedure especially benefitted children less than one year of age. Results of the study are published online in The Lancet Global Health.

CPAP can improve respiratory rate and survival in children with primary pulmonary diseases. The latest findings confirmed that no serious adverse events were associated with the treatment, it is safe and effective to use in district level hospitals, and a step forward in treating children with respiratory distress in resource-limited settings.

Sites for the Columbia study were two non-tertiary hospitals in Ghana where invasive mechanical ventilation was not routinely available, and nurses initiated and managed care with once or twice daily physician rounds. A sample size of 1025 participants in the CPAP group and 1175 in the control group was studied.

Two-week all-cause mortality in children 1 year of age and younger significantly decreased when non-invasive positive airway pressure was continuously applied -- 3 percent of patients in the CPAP group versus 7 percent of patients in the control group who were not given the therapy. In children of all ages - one month to 5 years, respiratory rate was significantly lower in the CPAP group at 4 hour, 8 hour, 12 hour, and 24 hour time points.

"In addition to demonstrating the safety of CPAP and the children's improved survival rates, our study is unique in that CPAP was initiated and managed at the first hospital level by emergency ward nurses who work much of the day without direct supervision by a physician," said Rachel T. Moresky, MD, MPH, Mailman School of Public Health associate professor of Population and Family Health, associate professor of Medicine, Emergency Medicine at Columbia University Medical Center, and senior author.

Dr. Moresky continued, "Other CPAP studies in low resource settings have been demonstrated at tertiary hospitals (or university hospitals) and with physician specialists applying the CPAP treatments. Our study demonstrates that by task sharing this skill to nurses, that lifesaving care can be brought closer to the community."

Pneumonia, sepsis, and severe malaria kill more than 2 million children younger than 5 years every year. These treatable illnesses can progress to respiratory failure. Most of these deaths occur in low-income and middle-income countries, where diagnostic and therapeutic interventions are often severely scarce.

The World Health Organization recommends redistributing health-care tasks to less highly trained individuals. With a nurse to doctor ratio of 8:1 in many African nations, successful training of nurses to effectively and safely apply CPAP will be crucial for its proliferation in non-tertiary hospitals.

"We aimed to evaluate the effectiveness of CPAP in a setting where nurses care for patients with limited physician oversight, and where certain sophisticated diagnostic tests are not routinely done which added value to our study," said Dr. Moresky, who is also director of the International Emergency Medicine Fellowship program at Columbia.

"Our findings coupled with the results from two smaller studies in Bangladesh and Malawi support the use of non-invasive ventilation for children presenting with acute respiratory distress in low-resource settings and are a step forward in codifying best practices for treating them," noted Patrick T. Wilson, MD, MPH, Columbia University Medical Center assistant professor of Pediatrics, Mailman School of Public Health assistant professor of Population and Family Health, and lead author.

The results also suggest that the use of CPAP in young children with respiratory insufficiency is appropriate in other parts of the developing world, where diagnostic capabilities are similarly limited. The study showed that for every 25 children under the age of 1 year treated with CPAP, one life can be saved and most patients will have improved respiratory rates for at least 24 hours.

Dr. Wilson concludes "The results of the study are remarkable in that it included children with a wide range of disease processes, making it more generalizable to real life settings in low- and middle-income countries around the world."


Co-authors: Sara Lopez-Pintado, Department of Biostatistics, Mailman School of Public Health; Frank Baiden, Ensign College of Public Health, Ghana; Joshua C Brooks, School of Medicine, University of Queensland-Ochsner, Brisbane, Australia; Marilyn C Morris, Department of Pediatrics, Columbia University Medical Center; Katie Giessler, Global Health Sciences, University of California San Francisco; Damien Punguyire, Municipal Health Directorate, Ghana; Gavin Apio, Kintampo Municipal Hospital, Ghana; Akua Agyeman-Ampromfi, Centre for Global Health Research, Ghana; Justice Sylverken, Department of Pediatrics, Komfo Anokye Teaching Hospital, Ghana; Kwadwo Nyarko-Jectey, Mampong Municipal Hospital, Ghana; and Harry Tagbor, School of Medicine, University of Health and Allied Sciences, Ghana

The study was supported by General Electric Foundation Columbia University sidHARTe Program (Grant PT-AABK1277).

Columbia University's Mailman School of Public Health

Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including ICAP and the Center for Infection and Immunity. For more information, please visit http://www.mailman.columbia.edu.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Source: https://www.eurekalert.org/pub_releases/20...