Q&A: On the COVID-19 Frontlines with Respiratory Therapy
COVID-19 is primarily a respiratory illness and it put respiratory therapists with Mary Greeley’s Cardiopulmonary department on full-alert. The specially trained therapists are responsible for providing life-saving breathing treatments and maintaining respiratory treatment tools, such as ventilators, which have never been as treasured than they are now.
Mary Greeley’s respiratory therapists have spent many hours treating COVID-19 patients, including those on ventilators in the Intensive Care Unit. Here, Sally Balvanz, RRT, and Kristin Hofland, RRT, Mary Greeley respiratory therapists, share their experiences during COVID-19.
Let’s talk about ventilators to start with, since there have been lots of questions and discussion about them during this pandemic. What is a ventilator?
Kristin: A ventilator is a medical device that assists a patient’s breathing. In basic terms, it delivers oxygen into the lungs and removes carbon dioxide when a patient is unable to breath on their own. A tube is inserted into a patient’s windpipe (trachea) and the ventilator circuit is attached to this tube, called an endotracheal tube. This process is called “intubation.” A ventilator can either be set to assist a patient’s breathing or totally take over their breathing, depending on the patient’s condition. There are many types of ventilators with various modes to decrease the patient’s work of breathing to ensure the body receives adequate oxygen and that carbon dioxide is removed. A ventilator does not heal the patient, it supports the patient while other therapies and medications are administered to treat the patient.
We should note that a ventilator is just one tool we have to treat respiratory illness. Not all COVID-19 patients need a ventilator.
Were there concerns about having enough ventilators?
Kristin: Respiratory has a limited number of ventilators – adequate for normal situations, but limited for a crisis like this. We had additional resources in Anesthesia and Patient Transport. We had great coordination in the region and acquired additional ventilators from area hospitals.
Treating patients with respiratory distress is what you’ve been trained to do, but did you have to do anything different when dealing with COVID-19?
Kristin: We did a lot of training to refresh skills. We trained on proper methods to put on and take off PPE. Something we call ‘donning and doffing.’ PPE protects us and everyone around us.
Sally: We also trained on using an intubation box, which uses suction to create a negative airflow during intubation and extubation. This prevents aerosolizing, or dispersing, the virus. Training also involved transporting patients throughout the hospital with a hood to prevent spread of the virus. We did training on anesthesia ventilators in the event that we need to utilize these ventilators, as well.
COVID 19 is obviously a severe respiratory illness. What has it been like for you and your colleagues during this pandemic?
Sally: Before we saw our first positive COVID-19 patient, we were fortunate enough to have the time to have mock codes so that we could run through different scenarios. Having the time to prepare, since there are multiple steps involved, made our process more efficient and our staff more confident when we did have our first positive COVID patient.
Kristin: We’re used to treating critical patients with chronic and acute respiratory failure. With this virus, we had to assess, adapt, and train for almost everything we do. There was a lot of unknowns and it was scary at first. Staff stayed in one patient’s room for extended times. This was done to preserve PPE (personal protective equipment). Another therapist was assigned as their “buddy” to assist them by acquiring items they needed, taking a blood sample or relieving them for a break.
Sally: A lot of great teamwork was involved, including physicians, respiratory therapists, nurses, Lab, Radiology, PCTs (patient care technicians), PTs (physical therapists), and many others. This was key to providing safe, quality care to these patients.
"Here Comes the Sun"
The Beatles classic plays through the medical center to celebrate a patient coming off a ventilator after battling COVID-19.
Watch the Video
You’ve seen COVID-19 patients being treated with ventilators. What’s it like for you to see a patient taken off a ventilator? It must provide a great sense of relief and satisfaction in the level of treatment you’ve provided.
Kristin: As soon as a patient gets intubated and placed on a ventilator, we think of ways to extubate the patient. We draw ABG's (arterial blood gases) to see what adjustments could be made to the ventilator, trying different lung recruitment maneuvers (a method to open collapsed airways), placing the patient in prone position (on their stomach), and giving inhaler treatments to help dilate the airways. When the patient has improved, and is stable enough to breathe on their own, we can pull the tube from their airway. It is so rewarding to see the techniques that we've used have worked. Hearing the patient speak for the first time after having the tube removed from their airway is one of the highlights of my job.
Sally: I have been an RT for more than 20 years and have extubated many patients ranging in age from one to 100 years old, and in both happy and sad circumstances. I was fortunate enough to extubate a COVID-19 patient and be a part of the celebration outside the room with staff who have worked so hard and tirelessly throughout this pandemic. The smile on the patient’s face was all we needed. It was one of those days in my RT career I’ll always remember. It is a wonderful feeling to get them one step closer to being back home with their families.
You are part of a team that works closely with COVID-19 patients. Were you worried about your exposure? Did you do anything special before heading home at the end of the day?
Kristin: At the end of each shift, I change out of my scrubs to reduce the potential exposure of COVID-19 to my family. I also wipe off my stethoscope, ID badge, watch and anything else that may have been exposed during my shift with disinfectant wipes. When I return home from work, my family understands they need to keep their distance until I have put my scrubs in the washer and have taken a shower. We are at high risk for exposure but we do this willingly because if the patient isn't breathing then very few things matter. In the end, it is more about the care that we are providing for the patients and easing their concerns and fears.