The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


Shari A. Toomey; Respiratory dept, Carilion Clinic, Hardy, VA

Background: Patients with broncholitis, Respiratory Syncytial Virus (RSV), and apnea can require all levels of respiratory support from a nasal cannula to intubation. As a patient’s respiratory status deteriorates the only options available are Non-invasive Positive Pressure Ventilation (NIPPV) or intubation. Current NIPPV interfaces are often uncomfortable, ill fitting, and time intensive for hospital caregivers. Intubation can lead to complications ranging from airway trauma, infection, and increased lung damage. “The Neotech RAM Cannula™ is clinically proven as a safe, effective, gentle and adaptable interface to deliver NCPAP or NIPPV/NIMV for respiratory support for the neonatal and pediatric population.” ( Our unit trialed this device to assess impact on intubated days and average length of stay (ALOS) of our PICU patients. Methods: In this study we compared data from patients 2010-2011 with prospective outcomes of care using the RAM cannula. We assessed rate of intubation and ALOS. Target population: Patients = 8 months of age, with a diagnosis of broncholitis, RSV or apnea requiring non-invasive ventilation or intubation. Patients meeting inclusion criteria were placed on the RAM Cannula. Results: In 2010-2011, 23 patients = 8 months of age were admitted to the PICU with a diagnosis of broncholitis, RSV or apnea with an ALOS of 5.15 days. In 2010, 14% of patients meeting inclusion criteria were intubated and 25% in 2011. In Jan 2012 we implemented the use of the RAM cannula. From Jan 1 to April 1, 31 patients = 8 months of age were admitted who met inclusion criteria, with an ALOS of 4.1 days. 7% of these patients were intubated and 35% received non-invasive ventilation via the RAM Cannula. Based on clinical assessment, many of these patients would have required intubation without implementation of the RAM cannula. Intubated patients after they met clinical indicators were placed on the RAM Cannula and did not require re-intubation. Conclusion: Implementation of the RAM Cannula guidelines resulted in a decrease in rate of endotracheal intubation and ALOS. We developed guidelines for use of the RAM Cannula that allow our PICU to standardize care and provide a comfortable interface for patients. We will continue to monitor outcomes of our usage of the RAM Cannula in a broader patient population. Sponsored Research - None