On front lines in the battle vs. COVID-19

REPOSTED FROM SCRANTON TIMES TRIBUNE

In recent months, the profession of respiratory therapy has received increased attention. Anyone reading the newspaper or watching the news on television will be aware of the important role that ventilators play in caring for patients affected by the COVID-19 virus. But what of the professionals who operate these devices? 

Today’s respiratory therapists have demanding responsibilities related to patient care and serve as vital members of the health care team. They can be found in acute-care hospital settings, including the emergency room and the intensive care unit, or in pulmonary rehabilitation settings.

Respiratory therapists must have a broad knowledge of the cardiopulmonary system and the relationship between the heart, lung and kidneys, and be able to manage the complex procedures required to diagnose and treat patients of all ages. 

Diagnoses that would bring us to a patient’s bedside include asthma, COPD, spinal cord injury, sleep apnea, bronchitis and emphysema, to name just a few. Respiratory therapists are trained to understand factors that lead to lung disease or injury, how that disease affects the rest of the body, and how to provide the most appropriate therapy or medication. For example, they may work with the patient on inspiratory exercises that help make the lungs become more efficient. There are also a large number of therapies available to aid in mucous clearance, something that can be hard for a patient with COPD. Oxygen therapy sometimes becomes necessary, either during periods when the patient’s condition has worsened or as a permanent support throughout the day and night. 

Patient education is an important part of successful respiratory therapy. Medicated inhalers and medication are two of the tools used in the treatment of common respiratory conditions. Patients, when using multiple inhalers, must learn how and when to use these tools, and to understand how their interaction and timing affects their health. When reviewing inhalation medications with your clinician or other provider, you should discuss the order and intervals at which you take them. 

The current health crisis has put an overwhelming pressure on ventilator supplies and on the qualified clinicians who operate them. For doctors, resorting to a ventilator is an extreme measure, used when a patient’s lungs cannot supply enough oxygen on their own. 

In these situations, a respiratory therapist’s knowledge is invaluable. Our training and experience equips us to monitor and manage the ventilator settings to keep the patient well ventilated and comfortable, and to ensure that a synchronized breathing pattern is present. Flow, volume and timing are very important.

Respiratory therapists also continually monitor the graphs and the flow patterns on the machine — important tools that can alert the therapist to any changes in the patient’s compliance and compatibility with the ventilator. These tools and measurements also show improvements the patient is making that can lead to adjustments to minimize the patient’s reliance on artificial ventilation. 

All hospitals and facilities that provide ventilators have an emergency plan in place that includes a number of backup ventilators. In addition, they have agreements with their suppliers in case of an unusual immediate need for more ventilators — typically about double what the facility currently uses. Hospitals and long-term care facilities often take into consideration worst-case scenarios when planning for the unexpected, but most assuredly not to the degree we have seen through this crisis. 

About the Author: Chris Richardson, Certified Respiratory Therapist, works with patients at Allied Services Rehab Hospital in Scranton and Heinz Rehab Hospital in Wilkes-Barre. He has more than 34 years of clinical experience.