Thank a Respiratory Therapist

As the COVID-19 pandemic slowly treads onward, we are beginning to see signs of improvement throughout the country. This is in part due to vaccine distribution, along with masking up and social distancing. There is still a long road ahead, but we are seeing signs of improvement and optimism. As we all know, this virus impacts our respiratory tract, with the intensity of symptoms varying greatly depending on age and other health factors. It's time that we recognize one of the most overlooked and most important roles in our healthcare system today: respiratory therapists.

Respiratory therapists are healthcare professionals trained to observe, educate, and treat patients with pulmonary and cardiopulmonary disorders. This includes patients with minor and severe breathing problems, patients on ventilators, and other respiratory conditions. During the pandemic, the biggest tasks for respiratory therapists have been managing ventilators and intubating patients. Mechanical ventilators are essentially a substitution for the body’s natural way of respiration. In a healthy body, the diaphragm contracts and creates negative pressure, or suction, that draws oxygen into our lungs. COVID-19 disrupts this process and prevents the lungs from receiving enough oxygen. Mechanical ventilation starts with intubating a tube through the mouth, nose, or trachea into the airway. This creates a stable, reliable, hollow tube to safely deliver oxygen and remove carbon dioxide from the lungs. The ventilator itself then pushes air through the tube into the lungs. This process allows the body’s respiratory muscles to rest and not have to work very hard to breathe because the ventilator is essentially acting as the lungs. This also protects the patient from injury from aspiration. It should be noted that mechanical ventilators are NOT a method of healing or fighting the novel coronavirus. It is simply a treatment to allow the body to rest while medications and other treatments actively work to fight off the infection. Ideally, we want patients to be off of the ventilator and breathing on their own as quickly as possible, but this process does not happen overnight. In the case of this virus, there haven't been many that have come off of ventilators. The nature of the virus leaves many patients in the hospital for long durations and many are on ventilators. This requires respiratory therapists to divide their time among many patients, both on and off ventilators. As cases were surging, we heard many reports about ventilator shortages and choices having to be made regarding which patients get them. Respiratory therapists have been thrown in the most dangerous and dire area of patient care. They, along with doctors, nurses, and other healthcare professionals, are selflessly placing themselves in the most risk of contracting the virus. These patients can be on ventilators for anywhere from one week to upwards of four or five. Many of these patients are nonresponsive while on the ventilators, further creating a dilemma regarding availability for new patients. Many respiratory therapists have noted that the effects of COVID-19 on their patients is much different than other diseases they have previously treated. They are more often unresponsive, and when they do become responsive it takes much longer than normal. Some respiratory therapists are having to use unconventional ventilation methods, such as pressure control or airway pressure release ventilation. There are two other types of care common to coronavirus patients in addition to mechanical ventilation: nasal cannula therapy and CPAP or BiPAP. It should be noted that these two methods are nowhere near as important as mechanical ventilation, but still an important aspect of the everyday tasks of respiratory therapists during this pandemic. Nasal cannula therapy, particularly heated high-flow nasal cannula therapy, involves providing 100% oxygen at a very high rate. It is a substitute for patients who are NOT in critical condition and are suffering slightly more mild symptoms. Candidates for nasal cannula therapy must be able to stay awake, breathe spontaneously, and hemodynamically stable. This allows respiratory therapists to use the ventilators for more severe patients who cannot breathe on their own at all. Benefits of nasal cannula therapy include keeping the patient awake and able to eat and drink, patients can be moved out of the ICU into inpatient areas, and patients can be more mobile and active. Patients are also on nasal cannula therapy half the time as they would be on ventilators if placed on one. This alternative is very helpful for respiratory therapists as they struggle to find enough ventilators to go around. Of course, not everyone meets the requirements for nasal cannula therapy, particularly those who are in serious condition and do not have functioning lungs. An alternative to nasal cannula therapy is a CPAP or BiPAP machine. When patients are able to breathe a little bit on their own but do not respond particularly well to nasal cannula therapy, a CPAP or BiPAP can be used. This machine uses a fitted mask over the face to push oxygen down into the lungs. You are probably familiar with people who wear one when they go to sleep at night, which is called sleep apnea.

Respiratory therapists are faced with the immense task of utilizing and deciding which methods they can use for COVID-19 patients. Day in and day out, they are placed in the most risk of contracting disease and treat the most sick patients in the ICU. If you know a respiratory therapist, thank them for being so incredibly hard working during this pandemic and for being one of the most vital components to our healthcare system during this pandemic. They truly are superheroes.