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.

https://www.youtube.com/watch?v=sKxK9ofLzCI

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.

Source:

https://www.aacn.org/

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.  

 

PUBLIC RELEASE: 20-JUN-2017

Applying continuous airway pressure improves respiratory and survival rates in children

 

COLUMBIA UNIVERSITY'S MAILMAN SCHOOL OF PUBLIC HEALTH

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...

Toronto Pulmonary Function Testing Symposium 2017

Pulmonary Function Testing Symposium 2017

Canadian Association of Cardio-Pulmonary Technologists

Friday, 22 September 2017 at 7:45 AM - Saturday, 23 September 2017 at 4:00 PM (EDT) Toronto ON

sponsored by the Canadian Association of Cardiopulmonary Technologists, Novus Medical Inc. and MGC Diagnostics.  Goto https://www.eventbrite.ca/e/pulmonary-function-testing-symposium-2017-tickets-33394162840?ref=ecount to register for this world class educational symposium for PFT and CPET.  

The Pulmonary Function Testing Symposium 2017 is a 2 day event involving presentations and workshops on topics in the field of Pulmonary Function Testing.  It is open to Pulmonary Function Technologist, Registered Cardio-Pulmonary Technologist, Respiratory Therapist and any other alllied health professional.  Great opportunity to meet others in the field, to have group discussions and to network.  

Hotel Information: for discounted rate contact Laura Seed – lseed@hotmail.com

Programme

Friday September 22, 2017

07:45 – 08:35 Registration and Continental Breakfast

08:35 – 08:45 Opening Remarks – Laura Seed RCPT(p), SickKids

08:45 – 09:30 Pulmonary function assessment of the COPD patient with a focus on rehabilitation - Dr. Chris Allen

09:30 – 10:15 Clinical Practice Parameters and Facility Standards. The Ontario model - Dr. Gottschalk, Hamilton & Lori Davis RCPT(p)

10:15 – 10:30 Refreshment Break

10:30 – 11:15 New inhalers for COPD and asthma: a user’s guide – Dr. Stanbrook, Toronto Western

11:15 – 12:00 Infection Prevention and Control - Angela Thomas, RN, SickKids

12:00 – 12.45 Lunch

12:45 – 14:15Technical Workshop A: Spirometry – Ontario Lung Association, Provider Education Program. (Accredited with the College of Family Physicians)
Technical Workshop B: Mapping your QC program – Susan Blonshine, RRT, TechEd Inc

14:15 – 14:30 Break

14:30 – 16:00Technical Workshop A: Mapping your QC program - Susan Blonshine, RRT, TechEd Inc
Technical Workshop B: Spirometry – Ontario Lung Association, Provider Education Program. (Accredited with the College of Family Physicians)

19:00 PFT Social – Monarch’s Pub, Chelsea Hotel.

Saturday September 23, 2017

08:00 – 08:30 Continental Breakfast

08:30 – 09:15 Spirometry: The Good, the Bad and the Ugly – David Wilson RCPT(p), SickKids

09:15 – 10:00 The ABCs of plethysmography – Dr. Allan Coates, SickKids

10:00 – 10:15 Refreshment Break

10:15 – 11:00 Predicted Values – Looking at confounding factors – Andrea White-Markham, RRT

11:00 – 11:45 Methacholine Challenge: What do we know now? – Dr. Myrna Dolovich, McMaster & Tony Kajnar RRT, Sault Area Hospital

11:45 – 12:00 Closing Remarks before workshops.

12:00 – 12:45 Lunch

12:45 – 14:15Technical Workshop C: Cardiopulmonary exercise testing – Jane Schneiderman, PhD & Susan Iori, R.Kin, SickKids
Technical Workshop D: Plethysmography workshop – Tony Kajnar, RRT, Sault Area Hospital

14:15 – 14:30 Break

14:30 – 16:00Technical Workshop C: Plethysmography workshop – Tony Kajnar, RRT, Sault Area Hospital
Technical Workshop D: Cardiopulmonary exercise testing – Jane Schneiderman, PhD & Susan Iori, R.Kin, SickKids

Have questions about Pulmonary Function Testing Symposium 2017? Contact Canadian Association of Cardio-Pulmonary Technologists

Sweetums 24% Sucrose

NEW to Novus Medical, Sweetums 24% Sucrose Solution - preservative free

Combined use of nonnutrative sucking and oral sucrose helps calm
and soothe infants undergoing procedures such as a heel stick and circumcision.

Why 24% sucrose solution?
Sucrose is a non-pharmacologic intervention that has been widely studied
and proven to be associated with statistically and clinically significant
reductions in infant discomfort.

Source: http://www.sandboxmedical.com/sweetums_pro...

Pulmonary Function Testing Symposium 2017

Pulmonary Function Testing Symposium 2017

Canadian Association of Cardio-Pulmonary Technologists

Friday, 22 September 2017 at 7:45 AM - Saturday, 23 September 2017 at 4:00 PM (EDT) Toronto ON

sponsored by the Canadian Association of Cardiopulmonary Technologists, Novus Medical Inc. and MGC Diagnostics.  Goto https://www.eventbrite.ca/e/pulmonary-function-testing-symposium-2017-tickets-33394162840?ref=ecount to register for this world class educational symposium for PFT and CPET.  

The Pulmonary Function Testing Symposium 2017 is a 2 day event involving presentations and workshops on topics in the field of Pulmonary Function Testing.  It is open to Pulmonary Function Technologist, Registered Cardio-Pulmonary Technologist, Respiratory Therapist and any other alllied health professional.  Great opportunity to meet others in the field, to have group discussions and to network.  

Hotel Information: for discounted rate contact Laura Seed – lseed@hotmail.com

Programme

Friday September 22, 2017

07:45 – 08:35 Registration and Continental Breakfast

08:35 – 08:45 Opening Remarks – Laura Seed RCPT(p), SickKids

08:45 – 09:30 Pulmonary function assessment of the COPD patient with a focus on rehabilitation - Dr. Chris Allen

09:30 – 10:15 Clinical Practice Parameters and Facility Standards. The Ontario model - Dr. Gottschalk, Hamilton & Lori Davis RCPT(p)

10:15 – 10:30 Refreshment Break

10:30 – 11:15 New inhalers for COPD and asthma: a user’s guide – Dr. Stanbrook, Toronto Western

11:15 – 12:00 Infection Prevention and Control - Angela Thomas, RN, SickKids

12:00 – 12.45 Lunch

12:45 – 14:15Technical Workshop A: Spirometry – Ontario Lung Association, Provider Education Program. (Accredited with the College of Family Physicians)
Technical Workshop B: Mapping your QC program – Susan Blonshine, RRT, TechEd Inc

14:15 – 14:30 Break

14:30 – 16:00Technical Workshop A: Mapping your QC program - Susan Blonshine, RRT, TechEd Inc
Technical Workshop B: Spirometry – Ontario Lung Association, Provider Education Program. (Accredited with the College of Family Physicians)

19:00 PFT Social – Monarch’s Pub, Chelsea Hotel.

Saturday September 23, 2017

08:00 – 08:30 Continental Breakfast

08:30 – 09:15 Spirometry: The Good, the Bad and the Ugly – David Wilson RCPT(p), SickKids

09:15 – 10:00 The ABCs of plethysmography – Dr. Allan Coates, SickKids

10:00 – 10:15 Refreshment Break

10:15 – 11:00 Predicted Values – Looking at confounding factors – Andrea White-Markham, RRT

11:00 – 11:45 Methacholine Challenge: What do we know now? – Dr. Myrna Dolovich, McMaster & Tony Kajnar RRT, Sault Area Hospital

11:45 – 12:00 Closing Remarks before workshops.

12:00 – 12:45 Lunch

12:45 – 14:15Technical Workshop C: Cardiopulmonary exercise testing – Jane Schneiderman, PhD & Susan Iori, R.Kin, SickKids
Technical Workshop D: Plethysmography workshop – Tony Kajnar, RRT, Sault Area Hospital

14:15 – 14:30 Break

14:30 – 16:00Technical Workshop C: Plethysmography workshop – Tony Kajnar, RRT, Sault Area Hospital
Technical Workshop D: Cardiopulmonary exercise testing – Jane Schneiderman, PhD & Susan Iori, R.Kin, SickKids

Have questions about Pulmonary Function Testing Symposium 2017? Contact Canadian Association of Cardio-Pulmonary Technologists

CSRT 2017 Highlights

Novus Medical Inc. sponsors the CSRT banquet entertainment for a second year

Novus Medical Inc. has sponsored the entertainment for a second year.  After a stepping in at the last minute to provide the entertainment for the banquet in 2016, Novus Medical Sales Manager and resident DJ, Dan Pinard was asked back to provided the musical entertainment for the 2017 banquet.  DJ Danny P kept the Respiratory Therapists letting loose and dancing until 1 am when it was time to close the banquet hall.  

In the exhibit hall, Novus Medical launched their new "Novus Green" Converse Chuck Taylors.   The bright green shoes contrasted by the black trousers was definitely a way to get noticed.  But seriously, the highlights of the Novus Medical booth had to the new Resmon PRO FOT from MGC Diagnostics and the new 17.3 inch Bellavista 1000e from IMT Medical.  The booth staff were busy doing demonstrations of these devices during exhibit hall hours for the duration of the conference.  For more information on the Resmon PRO and how it can add value to your PFT department email us at info@novusmedical.ca.  For more information about the iPad® of ventilators with the most advanced synchronization and forward thinking software, the Bellavista 1000e, please email info@novusmedical.ca.  For more information about the Novus Green Chuck Taylors ....well you should be able to find them at any fine sporting shoe stores in your area.  

Seeya next year in Vancouver.

 

PITSI Harness, a seat belt for transport incubators

The PITSI harness has been re-introduced into Canada, and is now distributed by Novus Medical Inc.  The PITSI was developed in conjunction with the Quebec EVAQ transport team, to secure infants being transported in the Draeger Transport Isollette.  The PITSI harness is a seat belt of sorts, that secures the infant at the shoulders and legs similar to a 5 point harness seen in race cars.  The PITSI has been specifically designed to allow access to the infant for procedures, blood work and invasive lines. 

The PITSI is a must for transporting infants in a transport incubator.  email Novus at info@novusmedical.ca for more information and pricing.  

CSRT 2017 Halifax and the launch of the Bellavista 1000e 17 inch

Novus Medical Inc. is looking forward to demonstrating Canada's newest and most sophisticated mechanical ventilator, the bellavista by IMT Medical.  The Swiss made bellavista ventilator features neonatal to adult ventilation, NIV, nCPAP, HFOT (high flow oxygen therapy) and lung recruitment tools.  One of bellavista's greatest advantages, is it's automated synchrony tools, especially important for NIV and pressure support ventilation.  

Novus will also be displaying the brand new bellavista 1000e with a 17 inch Gorilla Glass display.  

Come to the Novus Medical booth to get a demonstration of the bellavista and receive a ballot for a chance to win a UE Boom portable speaker valued at $250.00.  

Breath Test May Soon Detect Pneumonia-Causing Bacteria in ICU Patients on Ventilation

Breath Test May Soon Detect Pneumonia-Causing Bacteria in ICU Patients on Ventilation

MARCH 21, 2017

BY MAGDALENA KEGEL

 

A non-invasive test that relies only on collecting gases from a person’s breath may soon help doctors detect a potentially aggressive species of bacteria that causes pneumonia in intensive care unit (ICU) patients needing mechanical ventilation.

The new test may lead to more judicious use of antibiotics — a huge consideration given the ever-increasing rates of antibiotic resistance worldwide.

The study, Breath analysis for noninvasively differentiating Acinetobacter baumannii ventilator-associated pneumonia from its respiratory tract colonization of ventilated patients,” appeared in the Journal of Breath Research.

Acinetobacter (A.) baumannii is one of many bacterial species that can cause pneumonia in patients on mechanical ventilation. This so-called ventilator-associated pneumonia (VAP) can be the tipping point that kills already severely ill ICU patients. But A. baumannii presents a challenge for physicians trying to diagnose and treat ventilator-associated pneumonia. The bacteria resist nearly all available antibiotics; making matters even more complicated, it can exist in two different forms.

One form causes pneumonia, while the other simply colonizes the lung harmlessly. But so far, there has been no way for physicians to tell if a detected bacteria is causing disease or not. This, in turn, makes it more likely they’ll prescribe antibiotics unnecessarily.

To get around this situation, researchers at China’s Zhejiang University School of Medicine first analyzed volatile organic compounds, or gases, present in patients’ breath. Using the 52-bed ICU of the school’s Sir Run Run Shaw Hospital, they compared 20 patients with VAP caused by A. baumannii to 20 whose lungs had been colonized by the bacteria without apparent disease. In addition, they selected 20 patients who were ventilated but had neither pneumonia nor A. baumannii in their lungs as controls.

The team then compared the identified compounds to those emitted by the bacteria and kept in a lab dish. After a thorough analysis, they isolated four compounds present in both patients and lab-grown bacteria” 1-undecene, decanal, longifolene and tetradecane.

The test could discern not only between patients with no A. baumannii infection and those with the bacteria in their lungs, but also between infectious and colonizing forms of the bacteria. The 24-month study lasted from February 2014 to February 2016.

Researchers admit that the new method needs further testing and validation before being introduced as a routine tool. But they say it shows great promise in improving the diagnosis and treatment of pneumonia among already critically ill patients.

Source: https://pneumoniaresearchnews.com/2017/03/...

IMT Medical - the bellavista gateway

https://youtu.be/E5U0A4DGHZc

Enhancing the clinical use of the advantages

of Internet of things (IoT):

 

bellavista gateway, the new, innovative cloud service from imtmedical ag, increases the safety

of ventilated patients in ICU, high care, home care

and during transport.

bellavista gateway is our youngest brain child. The cloud-based respiratory care ventilation monitoring system allows medical staff to access the current monitoring and measurement data directly from the ventilator via a cloud solution, irrespective of the location, enabling them to monitor the ventilated patient as closely as required. This gateway allows a response with the necessary immediate medical assistance in an emergency at any time.

A clear improvement of the current situation
Until now, the safety of ventilated patients has been critically dependent on the monitoring cycle of the support staff. Enhancedpatient monitoring and an improvement in patient safety has only been possible with considerably higher costing solutions. In the event of an acute risk to the ventilated patient, the physician responsible for the ventilated patient either has to attend to or delegate ventilation changes.

Debunking myths in pulmonary function testing

to see the full article on the CJRT website, please go to http://www.cjrt.ca/article/20175301-05/

Jeffrey M Haynes, RRT, RPFT, FAARC

Author Affiliations

Pulmonary Function Laboratory, St Joseph Hospital, Nashua, NH

Correspondence: Jeffrey Haynes, Pulmonary Function Laboratory, St Joseph Hospital, 172 Kinsley St, Nashua, NH 03060, e-mail: gro.hnhjs@senyahj

This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http://creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact moc.trsc@rotide

Can J Respir Ther 2017;53(1):7–11

INTRODUCTION

The goal of evidence-based medicine is to move away from practices based on theory and replace them with practices based on robust scientific evidence. Unfortunately, many clinicians performing and interpreting pulmonary function tests dogmatically adhere to ideas based on theory despite evidence to the contrary. This paper will highlight examples of myths dressed up as science in the realm of pulmonary function testing. The goal of this paper is not just to inform but to also stimulate healthy debate and introspection about what we believe to be true and how these beliefs impact our practice and patient care.

MYTHS IN PULMONARY FUNCTION TESTING

Caffeine should be withheld prior to pulmonary function testing

As a member of the methylxanthine family, caffeine has been thought to possess bronchodilator properties. Because of this, the 1999 American Thoracic Society (ATS) guideline for methacholine and exercise testing recommended that caffeine-containing products be withheld on the day of testing [1]. While the 2005 ATS/European Respiratory Society guidelines for pulmonary function testing do not prohibit caffeine prior to testing [2], many laboratories continue to prohibit caffeine use prior to testing. It has been my experience that many patients are unhappy that they must withhold their morning coffee or tea prior to testing. Yurach et al [3] assessed the effect of caffeinated coffee on patients undergoing spirometry, methacholine challenge, and exhaled nitric oxide testing. The investigators found that a 16-ounce cup of coffee (~330 mg caffeine) had no effect on FEV1, methacholine responsiveness, or mean exhaled nitric oxide (Table 1). Precluding patients from ingesting usual amounts of caffeine prior to pulmonary function testing is unwarranted.

 

Note: Data are expressed as mean with standard deviation. FEV1,= forced expiratory volume in the first second; PC20, provocative concentration of methacholine causing a 20% decline in FEV1;FENO = fraction of expired nitric oxide; ppb, parts per billion. Table produced with data from Yurach et al [3].

*p > 0.05.

†Measured after decaffeinated coffee.

Patients are usually the cause of poor quality data

Numerous studies have documented a high prevalence of poor-quality spirometry testing in both the pulmonary function laboratory and office settings [4, 5]. This has occurred at a time when spirometer accuracy and reliability appears to be much better than in the past [6]. It is therefore not surprising that most technologists can be expected to blame poor patient effort and cooperation for poor test quality [7]. However, the literature clearly indicates that most patients, even children [8] and the elderly [9], are capable of producing high-quality pulmonary function data. The key to higher quality pulmonary function data is technologist performance monitoring and feedback [7]. In the Lung Health Study, Enright et al [10] documented a reduction in spirometry test quality after initial technologist training, which improved with retraining, but could only be sustained with a program of on-going technologist performance monitoring. Borg et al [4] evaluated the effect of technologist monitoring and feedback in two clinical pulmonary function laboratories. Prior to the intervention, lab #1 and lab #2 had poor test acceptability and reproducibility rates, 61% and 59%, respectively. Lab #1 implemented a technologist performance monitoring and feedback program and lab #2 did not. In response to the intervention, lab #1’s test quality rates rose to 92% while the quality of lab #2 remained poor at 65% (Figure 1). The unfortunate truth is that it is the technologist, and not the patient, who is usually the cause of poor quality testing. Pulmonary function laboratories should include technologist training and performance monitoring in their quality assurance programs.

 

 

FIGURE 1. The percentage of quality spirometry tests from two clinical laboratories. Baseline data from 2004 is compared to 2008 after lab #1 instituted an on-going technologist performance monitoring and feedback program. Figure produced with data from Borg et al [4].

Only high-quality spirometry tests are meaningful

As stated above, high-quality test results should be the goal of every pulmonary function laboratory. However, there are always going to be some patients, albeit a minority, that will not be able to produce high-quality spirometry. When spirometry quality is not perfect, many technologists reject sub-optimal tests to avoid reporting spurious data. While the practice of discarding less-than-perfect spirometry data is well intentioned, it may frequently discard clinically useful data. Using an A-B-C-D-F scoring strategy, Hankinson et al [11] found that only quality scores of D or F affected test interpretation. While we must always strive for maximum quality, technologists and physicians should exercise caution when discarding data.

Technologists must scream at patients to obtain quality spirometry results

A typical lesson in spirometry testing includes stressing the importance of using a loud voice, to the point of yelling or screaming test instructions, to obtain maximum effort and quality data. This practice has no basis in science and in most situations is completely unnecessary. Yelling or screaming spirometry instructions can be frightening to children, annoying to teens, and less audible to those with hearing deficits. Demonstrating the maneuver to the patient prior to testing and using suggestive body language during testing is more effective than yelling or screaming instructions at the patient. Studies should be conducted to investigate the best way to communicate pulmonary function test instructions to patients.

FEF25–75% aids in test interpretation

The forced expiratory flow over the middle half of the vital capacity (FEF25–75%) is believed by many to be representative of small airways function. A common interpretation of a “low FEF25–75%” is that the test results are “compatible with small airways disease.” The problem with this interpretation is that FEF25–75% has a very wide normal range [12]. Indeed, after age 70 years, one can have an FEF25–75% less than 50% of predicted and still be above the 5th percentile [13]. Quanjer et al [13] examined the impact of FEF25–75% on test interpretation, they found the incidence of FEF25–75% falling below the lower limit of normal as an isolated finding (i.e., normal FVC, FEV1, and FEV1/FVC) was only 2.75%. FEF25–75% adds virtually nothing to the information provided by FVC, FEV1, and FEV1/FVC.

DLCO/VA can normalize an abnormal DLCO

For many clinicians, the interpretation of diffusing capacity (DLCO) is based on both DLCO and the DLCO to alveolar volume ratio (DLCO/VA). While it is undeniable that DLCO and lung volume are directly related, this relationship is both complicated and difficult to predict [14, 15]. A common mistake is to declare an abnormal DLCO normal if the DLCO/VA is within the normal range. This implies that the DLCO is low due exclusively to a lack of lung volume, not alveolar–capillary pathology. A recently published study by Pastre et al [16] shows that DLCO/VA can often be within the normal range even in patients with significant parenchymal lung disease. Therefore, DLCO/VA is not a reliable parameter for inverse modeling (i.e., predicting structure from function) [17].

80% of predicted is a reliable lower limit of normal

The interpretation of pulmonary function data requires knowledge of expected values in subjects without respiratory disease. To this end, reference or “predicted” equations are generated. The mean or median value for a pulmonary function value is referred to as the “predicted value.” If the measured value is identical to the predicted value, the measured value is declared “100% of predicted.” If the data are normally distributed, the predicted value will be found at the center of a symmetrical bell curve. In other words, there are an equal number of normal values above and below the predicted value. A long-standing and fundamentally flawed technique to define the lower limit of normal (LLN) of pulmonary function values is to multiply the predicted value by 0.80. The so-called “80% of predicted” rule declares any value below 80% as abnormal and vice versa. In 1979, Sobol and Sobol [18] commented that “nowhere else in medicine is such a naïve view taken of the limit of normal.” The “80% rule” is statistically invalid for a number of reasons. Firstly, the normal ranges for different pulmonary function values are not identical. In addition, the normal variance around any value is affected by age, race, and gender [19]. As previously mentioned, after age 70 years, an FEF25–75% value less than 50% of predicted can still be normal [13]. Quanjer et al [20] found that using the “80% of predicted” rule and 0.70 as the LLN for FEV1/FVC misclassified >20% of patients. Wesolowski et al [21] documented that 14% of surgical lung cancer patients had pulmonary function values which were both <80% of predicted and above the LLN. This difference proved to be clinically important because having lung function below the LLN was a better predictor for perioperative complications than lung function <80% predicted but also ≥ LLN. Pulmonary function data should not be interpreted using 80% of predicted as the LLN (Figure 2, [22]).

 

 

FIGURE 2. The percent of predicted lower limit of normal as a function of age in males and females. The red horizontal dashed line represents 80% of predicted. LLN, lower limit of normal; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity. From Quanjer et al [22] (open access material under CC-BY-NC license).

A positive methacholine challenge confirms asthma

Methacholine challenge tests (MCT) are performed to test for the presence or absence of airway hyper-responsiveness (AHR) [23]. AHR is clearly a feature of asthma; however, AHR is not exclusive to asthma. For example, Leone et al [24] found that 46% of patients with non-allergic rhinitis with eosinophilia syndrome and no respiratory symptoms demonstrated AHR to methacholine. AHR is also a feature of COPD [25], sarcoidosis [26], and allergic rhinitis [27]. In addition, some subjects with no signs or symptoms of asthma demonstrate AHR to methacholine (asymptomatic AHR) [28, 29]. In patients with an intermediate pre-test probability of asthma, AHR in response to MCT may significantly increase the post-test probability of asthma. When the post-test probability of asthma is higher than the pre-test probability of asthma, a working diagnosis can be made. However, it is prudent to document an improvement in symptoms and lung function in response to therapy before making a working diagnosis of asthma official.

A negative methacholine challenge excludes asthma

As mentioned above, MCTs are performed to test for the presence or absence of AHR [23]. A lack of demonstrable AHR in response to MCT may significantly decrease the post-test probability of asthma; however, the sensitivity of MCT is not 100%. Indeed, Anderson et al [30] found that 45% of children with a positive exercise challenge had a negative methacholine challenge. In a study of elite athletes, the sensitivity of MCT to identify a positive response to eucapnic voluntary hyperventilation was only 36% [31]. The failure of MCT to identify asthma with perfect sensitivity is multi-factorial including both physiologic and technological considerations.

From a physiologic standpoint, phenotypic differences among asthmatics may affect the response to MCT [32]. In addition, the response to methacholine may be affected by seasonal variations in AHR. For example, Sposato et al [33] found a greater prevalence of AHR to methacholine in the spring and fall than during the summer months. Fruchter and Yigla [34] also found a higher incidence of AHR to methacholine in winter and spring when compared to summer. It is probably not uncommon for a patient to experience respiratory symptoms during the height of spring pollen season but not have their MCT scheduled until months later, after their allergen exposure has waned.

There are also technologic and methodological factors that can affect the results of a MCT. Methacholine dose, nebulizer type, inhalation method (e.g., dosimeter versus tidal breathing), and the threshold for a “positive test” can all affect MCT interpretation [1].

The impact of the bronchodilatory and bronchoprotective effect of deep inhalation on MCT has received a lot of attention. Cockcroft and Davis [35] have shown that using the full inhalation dosimeter method can significantly reduce the response to MCT and may result in false negative tests in patients with mild AHR.

In addition, relying solely on FEV1 as a MCT outcome measure may reduce MCT sensitivity for AHR. An example of a patient with respiratory symptoms, markedly reduced specific conductance (sGaw), yet little to no change in FEV1 during MCT is shown in Figure 3 [36]. Khalid et al [37] evaluated sGaw and FEV1 in 138 patients undergoing a MCT. The researchers found that a 51–52% reduction in sGaw was a more appropriate cut-off point for a positive MCT than the 45% reduction recommended by the ATS [1]. A remarkable finding was that 32 patients with an FEV1 decline <20% had a reduction in sGaw >50% (Figure 4). In a similar study, Parker and McCool [38] measured FEV1 and sGaw following MCT in 248 consecutive patients with asthma-like symptoms. Forty patients showed a response to methacholine as assessed by sGaw (≥ 40% reduction) without a significant decline in FEV1 (<20%). A negative MCT reduces the post-test probability of asthma; however, clinicians should be mindful that a negative MCT cannot rule out asthma with 100% certainty.

 

 

FIGURE 3. sGaw and FEV1 in a symptomatic patient during a MCT. (A) Baseline testing before methcholine challenge test (MCT). (B) Post MCT. (C) Post BD administration. sGaw, specific airway conductance; FEV1. forced expiratory volume in 1 second; MCT, methacholine challenge test; BD, bronchodilator). From Haynes [35] with permission.

 

 

FIGURE 4. Change in sGaw versus FEV1 in patients undergoing MCT. The red square includes subjects with a >50% reduction in sGaw with a <20% reduction in FEV1. The black line is the linear regression line. sGaw, specific airway conductance; FEV1, forced expiratory volume in 1 second; MCT, methacholine challenge test. From Khalid et al [36] with permission.

A negative exercise challenge test excludes exercise-induced bronchospasm

Exercise challenge tests are commonly performed to identify or exclude exercise-induced bronchospasm as the source of exercise limitation and symptomatology [1, 39]. An obvious limitation of exercise challenge tests is that they are not performed under the same circumstances as those from where the patient’s symptoms originate. This is perhaps no more true than patients involved in cold-weather athletics. Rundell et al [40] performed field exercise challenge testing in elite cold-weather athletes; 78% of athletes with a positive field exercise challenge test had a negative exercise challenge test in a clinical laboratory. Differences between field and laboratory testing may be due to differences in exercise pattern and intensity as well as environmental factors such as ambient humidity and air quality. Anderson et al [41] performed two exercise challenge tests within four days in 373 subjects with asthma-like symptoms associated with exercise. While most subjects had either two positive or two negative tests, 23.9% of subjects had conflicting results (i.e., one positive, one negative). Exercise intensity could not explain the differences in test outcome. For these reasons, a single negative exercise challenge test cannot by itself exclude the possibility of exercise-induced bronchoconstriction.

Normal spirometry excludes emphysema

An irreversible obstructive spirometry test in a patient with COPD risk factors defines the disease [42]. However, over the past several years it has become known that COPD has many phenotypes [43]. Some of these phenotypes refute the paradigm that normal spirometry precludes COPD pathology. For example, the COPDGene investigators found that 24% of current or former smokers with normal spirometry and a GOLD 0 classification had computed tomography evidence of emphysema [43]. Another poorly appreciated syndrome associated with cigarette smoking is combined pulmonary fibrosis emphysema (CPFE). Patients with CPFE have radiologic evidence of upper lobe emphysema and lower lobe fibrosis [44]. Patients with CPFE typically have a low diffusing capacity, elevated alveolar–arterial oxygen gradient, but normal spirometry and lung volumes [45]. Relying solely on spirometry to diagnose or exclude disease in symptomatic smokers can be expected to misdiagnose many patients with emphysema and CPFE.

Delta FEV1 effectively assesses bronchodilator response in COPD

As mentioned above, spirometric indices such as FEV1 are widely relied upon to make a diagnosis of COPD. As a consequence, many clinicians use ∆FEV1 to assess bronchodilator response/benefit in COPD patients. While patients with COPD can demonstrate significant increases in FEV1 after bronchodilator, many do not. A not so uncommon yet mistaken conclusion is that an insignificant ∆FEV1 indicates a lack of therapeutic efficacy. However, it is important to keep in mind that COPD patients seek medical care for dyspnea, not a recalcitrant FEV1. Bronchodilators reduce dyspnea on exertion by reducing the rate of dynamic hyperinflation [46], which may not be accompanied by an arbitrarily agreed upon “significant” ∆FEV1. O’Donnell et al [47] studied acute bronchodilator response in COPD patients who did not show improvement in FEV1. These patients showed significant reduction in hyperinflation (i.e., increased inspiratory capacity, reduced residual volume) despite no change in FEV1. Similar findings were recently shown by McCartney et al [48]. In their study, many COPD patients showed marked reduction in residual volume after bronchodilator despite little change in FEV1. Judging bronchodilator response in COPD patients solely on ∆FEV1 may lead to an under-appreciation of clinically important improvements in lung function, exercise capacity, and quality-of-life.

SUMMARY

Evidence-based medicine has revolutionized both diagnostics and therapeutics. However, the age of evidence-based medicine has not made pulmonary function laboratories immune from policies, procedures, and mistaken beliefs borne of myth and unproven theory. Indeed, pulmonary function guidelines contain recommendations based on both scientific data and unproven expert opinions. Pulmonary function technologists should be on the forefront of incorporating evidence-based practices in pulmonary function laboratories.

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PITSI Neonatal Transport Harness Now Available for Sale in Canada

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New MGC Diagnostics PFT machine at CVHC can help identify lung problems

If you have a lung disease such as asthma or COPD, or are having symptoms of lung problems, your doctor may order a Pulmonary Function Test (PFT) and set you up with an appointment to see Mary Curtis, the Certified Respiratory Therapist at Clearwater Valley Hospital and Clinics.

In order to make these tests easier for patients and to deliver more accurate results CVHC recently acquired a new PFT machine.

“The new machine checks how the patient is breathing, how they are able to take air into and out of their lungs, how well the oxygen is able to transfer into the blood stream when it is into the lungs, and also the lung volumes,” says Curtis. “The machine also measures lung volumes and it will tell us if a patient is air trapping (difficulty exhaling completely) or not.”

These tests are commonly ordered by a patients Primary Care Provider, the VA, a cardiologist, or a pulmonologist. PFT tests are typically scheduled Monday - Friday between 10 a.m. and 3 p.m. and they usually take about an hour to complete.

If you haven’t been to see Mary Curtis recently, know that she moved into the old radiology area in the hospital building. If patients need to speak with radiology now they will need to check in with the outpatient receptionist.

The PFT machine is located in Mary’s new office and is designed to be easy for Mary to use (and even easier for patients). The machine’s benefits include faster set-up, minimal analysis time, and unprecedented patient comfort.

“If you have any additional questions, or think you might benefit form a PFT test, please talk to your primary care provider at CVHC,” says Curtis.

Dynamic driving pressure associated mortality in acute respiratory distress syndrome with extracorporeal membrane oxygenation

The survival predictors and optimal mechanical ventilator settings in patients with severe acute respiratory distress syndrome (ARDS) undergoing extracorporeal membrane oxygenation (ECMO) are uncertain. This study was designed to investigate the influences of clinical variables and mechanical ventilation settings on the outcomes for severe ARDS patients receiving ECMO. 

 

Methods: We reviewed severe ARDS patients who received ECMO due to refractory hypoxemia from May 2006 to October 2015.

 

Serial mechanical ventilator settings before and after ECMO and factors associated with survival were analyzed. 

 

Results: A total of 158 severe ARDS patients received ECMO were finally analyzed. Overall intensive care unit (ICU) mortality was 55.1%.

 

After ECMO initiation, tidal volume, peak inspiratory pressure and dynamic driving pressure were decreased, while positive end-expiratory pressure levels were relative maintained. After ECMO initiation, nonsurvivors had significantly higher dynamic driving pressure until day 7 than survivors.

 

Cox proportional hazards regression model revealed that immunocompromised [hazard ratio 1.957; 95% confidence interval (CI) 1.216–3.147; p = 0.006], Acute Physiology and Chronic Health Evaluation (APACHE) II score (hazard ratio 1.039; 95% CI 1.005–1.073; p = 0.023), ARDS duration before ECMO (hazard ratio 1.002; 95% CI 1.000–1.003; p = 0.029) and mean dynamic driving pressure from day 1 to 3 on ECMO (hazard ratio 1.070; 95% CI 1.026–1.116; p = 0.002) were independently associated with ICU mortality. 

 

Conclusions: For severe ARDS patients receiving ECMO, immunocompromised status, APACHE II score and the duration of ARDS before ECMO initiation were significantly associated with ICU survival. Higher dynamic driving pressure during first 3 days of ECMO support was also independently associated with increased ICU mortality.

Noninvasive Breathing Support Device Seen to Help DMD Patient Live to Mid-50s in Case Report

A Duchenne muscular dystrophy (DMD) patient who is now in his 50s gained the notice of researchers, who say his case could illustrate the benefits of noninvasive mechanical ventilation in patients with well-maintained cardiac function.

It is the first report of a patient living into his sixth decade.

The report, “New Survival Target for Duchenne Muscular Dystrophy,” was published in the American Journal of Physical Medicine & Rehabilitation.

DMD patients’ life expectancy has improved significantly, in part because of improvements in ventilation support systems.
“Without ventilatory support, DMD survival did not extend much beyond teen years,” the team wrote. “However, with advances in cardiorespiratory care, life expectancy has increased into the late 20s for patients using continuous tracheostomy ventilatory support and is approximately 40 years for patients using continuous noninvasive ventilatory support.”

The patient in the case report was 53 when evaluated by researchers (he was born in September 1962). He was diagnosed with a typical phenotype and clinical history of DMD.

“Because of improvements in cardiopulmonary care, there has been a great improvement in survival and preservation of quality of life for many of these patients. Whereas it is no longer rare to find patients with Duchenne muscular dystrophy living into their fifth decade, this is the first report of a patient in his sixth decade of life,” the authors wrote.

The man has been able to maintain cardiac function, which is notable because cardiac dysfunction is common in DMD patients. (An unrelated study showed that, in a population of DMD patients, 96% had cardiomyopathies, or abnormalities in their heart muscles.)

“The reason why this patient with typical phenotypic Duchenne muscular dystrophy has preserved cardiac function is unclear. It may be partly because dystrophin has different functions in skeletal and cardiac muscle, or quite possibly, because of his particular point mutation in the dystrophin gene that we have been unable to find reported elsewhere,” the team wrote.

“We believe his survival is due to well-preserved cardiac function along with continuous noninvasive mechanical ventilation,” they wrote. Noninvasive mechanical ventilation is a modality that supports breathing without the need for intubation or surgical airway,” they wrote.

Altogether, this case report suggests that noninvasive mechanical ventilation may be particularly beneficial in enhancing survival of patients with preserved cardiac function.

One-third of Adults Diagnosed with Asthma Don't Have the Disease, Canadian Study Finds

A new research study revealed that 33 percent of adults in Canada who were diagnosed with asthma in the last five years do not have active asthma after all.

The study, “Re-evaluation of Diagnosis in Adults With Physician-Diagnosed Asthma,” was published in the Journal of the American Medical Association.

Lead author of the study was Dr. Shawn Aaron, a senior scientist and respirologist at Ottawa Hospital in Canada. In 2008 he had suggested that about 30 percent of asthma patients had been misdiagnosed. These findings confirm his suspicions.

Of the 613 randomly selected patients from 10 Canadian cities who participated in the study, 33 percent were found to not have asthma. Of those patients, about 90 percent were able to stop their medication and stay off it for at least one year with no threat to their health.

The team concluded that 80 percent of the patients who didn’t have asthma had been taking medication unnecessarily for over a year, and 35 percent of them had been taking medication every day.

“It’s impossible to say how many of these patients were originally misdiagnosed with asthma, and how many have asthma that is no longer active,” Aaron said in a press release. “What we do know is that they were all able to stop taking medication that they didn’t need – medication that is expensive and can have side effects.”

“Doctors wouldn’t diagnose diabetes without checking blood sugar levels, or a broken bone without ordering an x-ray,” he said. “But for some reason many doctors are not ordering the spirometry tests that can definitely diagnose asthma.”

To determine how these study participants had been diagnosed in the first place, investigators looked at all the medical records of patients they could access (530 in total). They found that in 49 percent of the cases, physicians had not ordered the airflow tests needed to confirm a diagnosis and had based their decision on their own observations and their patients’ self-reported symptoms.

In total, 28 percent of the participants did not have anything wrong with their health, and only 2 percent actually suffered from a serious condition like pulmonary hypertension or heart disease. Patients found to be disease-free stopped taking their asthma medication, while the remaining patients began taking the correct medicine right away.

“It wasn’t a surprise to most patients when we told them they didn’t have asthma,” Aaron said. “Some knew all along that their puffer wasn’t working, while others were concerned that they might have something more serious. Thankfully, the majority of the conditions were mild and easily treated.”

“We need to educate physicians and the public to get the diagnosis right in the first place,” he added. “Patients who have difficulty breathing should ask their doctor to order a breathing test (spirometry) to determine if they might have asthma or even chronic obstructive pulmonary disease (COPD).”

And, if patients think they may have been misdiagnosed or no longer have the disease, they should ask their doctor for a spirometry test, he said. “Asthma can be deadly, so patients should never go off their medication without speaking to a doctor first,” Aaron said.