FYI from the NHLBI Index
May 2009: Vol. 10, Issue 1
In the News
News from Capitol Hill
Science Advance from the NHLBI
- New Mechanical Ventilation Strategy Improves Outcomes for ARDS Patients
News from Capitol Hill
American Recovery and Reinvestment Act
On February 17, 2009, the President signed into law the American Recovery and Reinvestment Act
(Recovery Act or ARRA). The Recovery Act provides a one-time 34 percent budget increase of $10.4
billion to the NIH. Of that amount, the NHLBI will receive approximately 10 percent of the $7.4
billion to be invested by the NIH Institutes and Centers to support scientific research; an amount
that is proportional to the NHLBI’s appropriation level.
Appropriations for Fiscal Year (FY) 2009
On March 11, 2009, the President signed into law H.R. 1105 (P.L. 111-8),
the FY 2009 Omnibus Appropriations Act. The law includes the nine appropriations measures covered by the
Continuing Resolution through March 11, 2009, providing funding to the NIH for the remainder of FY 2009.
The HHS portion of H.R.1105 includes more than $30 billion for the 26 accounts that constitute the NIH
Executive Order on Stem Cells
On March 9, 2009, the President signed an Executive Order (EO) removing restrictions
on federal funding of human embryonic stem cell research. The order revokes the presidential statement
of August 9, 2001, limiting federal funding for research involving human embryonic stem cells, and
EO13435 of June 20, 2007, which supplements the August 9, 2001, statement. The EO requires the HHS
Secretary, through the NIH Director, to review existing NIH and other widely-recognized guidelines on
human stem cell research and issue new NIH guidance within 120 days.
New HHS Secretary Confirmed
On April 28, 2009, the Senate confirmed Kansas Governor Kathleen Sebelius as
Secretary of the Department of Health and Human Services (HHS). She was nominated by the President
on March 2, 2009.
Recent Advance from the NHLBI
New Mechanical Ventilation Strategy Improves Outcomes for ARDS Patients
Acute respiratory distress syndrome (ARDS) is a serious lung injury that is characterized by
pulmonary edema and high mortality. The only effective therapy is mechanical ventilation. In
recent years, a significant clinical breakthrough was achieved when investigators determined
that mechanical ventilation using a small breath size, or tidal volume, is clearly superior to
using large volumes. Although this approach significantly improved the survival of ARDS
patients, the mortality rate still exceeds 30 percent — and subsequent efforts to improve
the survival rate have been unsuccessful.
Results from a new trial indicate that clinical outcomes for ARDS patients can be significantly
improved over results achieved through standard ventilator therapy by adjusting the level of mechanical
ventilation pressure to account for characteristics of an individual patient’s lung and chest wall,
which are determined by pressure readings measured in the esophagus. Investigators used a balloon
catheter to measure the esophageal pressure for each patient, then either slightly increased or decreased
the amount of ventilation pressure applied to the lungs at the end of each breath depending on whether
the esophageal pressure was high or low, respectively. The study designers initially believed that 100
patients per treatment group would be necessary to detect a statistically relevant difference between
standard ventilator therapy and the esophageal-pressure–guided approach; however, lung oxygenation, a
predictor of ARDS survival, was improved so significantly by the new approach that treatment of only
60 patients with the new method was sufficient to validate its efficacy, and the study was halted early.
If confirmed in larger clinical trials, this new strategy of determining a patient’s esophageal pressure
and then adjusting the mechanical ventilator pressure accordingly may lead to a substantial improvement in ARDS survival.
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