Volume 9 Number 2 April-May 2014 The Journal of Pulmonary Technique Con dence Ad is in the air.page 2 Provide an extra measure of protection— with con dence. The new AnchorFast Guard oral endotracheal tube fastener features an integrated tube protection sleeve to help prevent tube occlusion. See how we’re helping you put patients rst— with con dence. Call 1.888.740.8999 or visit www.anchorfast1.com AnchorFast Guard Now with tube protection Oral Endotracheal Tube Fastener Caution: Federal (USA) Law restricts this device to Hollister and logo and AnchorFast Guard sale by or on the order of a physician. Prior to using the are trademarks of Hollister Incorporated. AnchorFast Guard oral endotracheal tube fastener, © 2014 Hollister Incorporated AFGRTH be sure to read the entire product Instructions for Use package insert that accompanies the product. HO_TAD_AnchorFast Ad RT_US_ RespTherapy.indd 1 12/17/13 1:38 PM TM Streamlin you Ad Workflo page 3 nSpire Health - thinking the way you do. nSight pulmonary function software suite’s intuitive design mimics practice workflow, while its simple and flexible navigation mirrors a physician’s thinking process. Anytime/anywhere remote access to PFT related information via HDweb on your iPad, Android tablet or any Internet browser, nSpire Health puts you back in control of your day, interpreting patient tests and digitally signing in under a minute! nSight™ streamlined PFT testing software nSight Central™ configurable launch pad HDweb™ rapid remote data access powered by iFlow HDnet™ EMR/HIS networking & connectivity iFlow™ PFT accuracy enhancement technology www.nspirehealth.com • 1-800-574-7374 scan for more information Volume 9 Number 2 April-May 2014 Editorial The Journal of Pulmonary Technique Cell-based Therapies: Beginning of a New Era? Recent advances in medicine have resulted in improved survival for our tiniest and most vulnerable preterm infants born at the edge of viability. Unfortunately, this increasing survival is at the expense of an increase in morbidities such as chronic lung disease (aka bronchopulmonary dysplasia, BPD), neurological impairment, and behavioral issues. BPD was first described by Northway almost four decades back as a respiratory disease of now near-term infants who require oxygen and/or mechanical ventilation. Since then, the disease itself has been modified which is now referred to as new BPD and is clinically defined as oxygen requirement of > 21% for at least > 28 days as assessed at 36 weeks corrected gestational age. Despite advancements in care, the disease itself has not changed Vol. 9 No. 2 with limited understanding and available therapies. At present, approximately 1 in 3 infants born less than 30 weeks gestational age develop BPD, varying from mild to severe. April-May 2014 Alexander Maximow first used the term “stem cell” to describe hematopoiesis where all blood cells develop from a single precursor cell. Since then considerable interest has developed in stem cell field and their utilization for therapeutic purposes. Recent years have seen an increase in hype about stem cell-based therapies for diseases like BPD. Although animal research has shown promising results with stem cell use in various disease models, data are lacking on their effectiveness in humans. Similarly, several preclinical and clinical papers have described a potential role of stem cells in lung diseases and BPD. Stem cells can be harvested from amniotic fluid, embryo, bone, blood, Table of Contents and umbilical cord. Challenge in stem cell field is that the biggest advantage of a stem cell is also its biggest DEPARTMENTS disadvantage. The word stem cell is self-explanatory in the sense that a single stem cell has a potential for self-propagation and inadvertent growth leading to tumor formation. 4 Editorial This has limited investigators in making final dossier of stem cells to be used as a therapeutic modality. Work in animal models utilizing stem cell conditioned media/ 12 News secretome which is free of cells has shown promising results like stem cells themselves in prevention and/or reversal of BPD. Interest of pharmaceutical companies in this exciting 17 Preview: Focus Convention field is paramount but at present outside the United States given federal regulations. In fact, the very first human trial of utilization of stem cells for BPD treatment has 20 Interviews been conducted in Korea approved by the Korean FDA. The trial drug, Pneumostem, is comprised of human umbilical cord-derived mesenchymal stem cells manufactured by 24 Oximetry Roundtables Medipost Co Ltd. and the trial was registered at clinicaltrials.gov. Although this trial has been completed in 2012, the results are still not released despite the fact that phase 2 trial has been in progress already. ARTICLES Given so much uncertainty about the proper dose and mode of delivery of stem cells 27 Assessment of Endotracheal and/or their secretome and reports of stem cell-based therapies outside US, the National Tube Obstruction Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health convened the Cell Therapy for Lung Disease Working Group in 2012 to review and formulate 32 Get M.O.R.E. out of Patient Care recommendations for future research directions. The group concluded that cell-based therapies are a new pillar of drug development but further bench work is required before 35 Use of Surfactant Therapy these therapies can be pioneered to bedside approaches. Work on questions like cell origin, mode of delivery, cellular vs. cell-free dossier, mechanistic assessments, side effect 37 Perioperative Implementation profile, etc. should run parallel to the standard clinical trials to maximize efficacy and of CPAP minimize side effects. 42 Lifestyle Benefits of NIOV In conclusion, cell-based therapies are a new era of treatment for BPD and other lung diseases which currently lack effective treatment but an aggressive bench and bench-to- 44 Biphasic Cuirass Ventilation to bedside approach is needed to make this a reality. Expedite Weaning Muhammad Aslam, MD 49 Benefits of Breathing Heliox Associate Professor of Pediatrics University of California, Irvine 51 Use of Short Questionnaires Neonatologist UC Irvine Medical Center 59 Chronic Cough and OSA Orange, California 4 Respiratory Therapy Vol. 9 No. 2 n April-May 2014 Ad The Vest® Airway Clearance System In hospital* and in home page 5 * In-hospital model not shown. Help your patients Breathe a Little Easier™ from hospital to home. Only from Hill-Rom METATHERAPY® TREATMENT WITH THE METANEB® SYSTEM 3 in 1 therapy combining lung expansion, secretion clearance and aerosol delivery into a single integrated therapy cycle. THE VEST® AIRWAY CLEARANCE SYSTEM Assisting patients in mobilizing retained secretions that may The MetaNeb® System In hospital otherwise contribute to increased rates of respiratory infection and reduced lung function. Global provider of respiratory care. Learn more by calling 800-426-4224 option #3 or visiting www.metaneb.com or www.thevest.com. MetaNeb® is a registered trademark of Comedica, Inc. The Vest® and Breathe a Little Easier™ are trademarks or registered trademarks of Hill-Rom Services PTE Ltd. Enhancing Outcomes for Patients and Their Caregivers is a registered trademark of Hill-Rom Services, Inc. The Vest System is o ered in the home by Advanced Respiratory, Inc, a Hill-Rom company. Hill-Rom reserves the right to make changes without notice in design, speci cations and models. The only warranty Hill-Rom makes is the express written warranty extended on sale or rental of its products. © 2013 Hill-Rom Services PTE Ltd. ALL RIGHTS RESERVED. Hill-Rom-AM14-Placed.indd 1 2014-02-25 11:00 AM Editorial Advisory Board Mohammed Al Ahmari, PhD, MSc, RRT Dr. Miguel Goncalves Kenneth Miller, MEd, RRT-NPS, AE-C ISSN 2152-355X AARC Intl Fellow Pulmonology Department and ICU and Clinical Educator, Dean of Wellness, Published six times each year by Director, Respiratory Care Program Emergency Department Respiratory Care Services Goldstein and Associates, Inc. King Fahd Military Medical Complex & University Hospital of S. João School Lehigh Valley Health Network 10940 Wilshire Blvd., Suite 600 Prince Sultan College of Health Faculty of Medicine Allentown, PA Sciences University of Porto, Portugal Nawal M. Mofarreh Los Angeles, CA 90024 USA Al-Khobar, Saudi Arabia Joshua F. Gonzales, MHA, RRT-NPS, MBBS, Arab Board-Internal Tel: 310-443-4109 · Fax: 310-443-4110 Prof. Nicolino Ambrosino, Head, RRT-SDS, RCP Medicine I, Cardiac Center- E-mail: [email protected] Pulmonary Unit, Cardio-Thoracic Associate Professor Al-Thawra General Modern Hospital, Website: www.respiratorytherapy.ca Department Department of Respiratory Care CPR Instructor & Co-Ordinator University Hospital, Pisa; Head, Texas State University Saudi Heart Association in affiliation Publisher/Editor in Chief Pulmonary Rehabilitation and San Marcos, TX with American Heart Association, CPR Steve Goldstein Weaning Unit Rik Goselink, PT, PhD Center, Al-Thawra Hospital Auxilium Vitae, Volterra, Italy Professor, Rehabilitation Sciences Sana’a-Yemen Managing Editor Christopher Hiscox Muhammad Aslam, MD Dean, Faculty of Kinesiology and Richard J. Morishige, MS, RRT, RCP, Senior Editor Chris Campbell Associate Professor of Pediatrics Rehabilitation Sciences RAC News Editor Vincent Terrier University of California Irvine Universitaire Ziekenhuizen Leuven/ Director, Clinical Affairs Associate Editor Jordana Hammeke Neonatologist Katholieke Uniersiteit Leuven, Belgium Breathe Technologies,