WHAT DO RESPIRATORY THERAPISTS DO?

Before I became one in 1992, I had no idea what a respiratory therapist did. In fact, I didn’t even know that the profession existed. Most people do not. So let me explain what we respiratory therapists do.

Respiratory therapists are specialists in anything to do with breathing, the lungs, and the heart. They work in hospitals alongside doctors, nurses, surgeons, and other health care specialists.

What does a respiratory therapist actually do?

In the emergency room, they are at the head of the bed ensuring the patient’s airway is patent. In the operating room, they help with bronchoscopies, intubation, and tracheostomies. Respiratory therapists are the ones using the resuscitation bag to help patients breathe in a crisis. They administer therapies like nebulizer treatments, CPAP, BiPAP, and mechanical ventilation. They draw blood for arterial blood gases, check oxygen and carbon dioxide levels, and ventilate patients who are not breathing.

Respiratory therapists guide other providers on the setting and changes of respiratory equipment. They work with the RNs and paramedics on Life Flights. They teach asthma education in schools. They work in pulmonary rehabilitation helping patients adjust to living with pulmonary disease.

Entering the Respiratory Therapy Profession

Respiratory therapists are trained in CPR and advanced life support. They work in hospitals, doctors’ offices, and nursing homes. Some RTs do homecare while others teach respiratory care in local colleges, preparing the next class of therapists.

The demand for respiratory therapists is growing at nearly 20% per year. Given that Covid-19 has been a huge driver of that growth, it is only to be expected that the demand surge will continue into the future.

In fact, the pandemic has shown us just how valuable the profession is in the healthcare continuum. It has been respiratory therapists first in the emergency room helping out-of-breath Covid-19 patients breathe, and respiratory therapists setting up, maintaining, and caring for the ICU patients on ventilators.

What does a Respiratory Therapist do on the Job?

Our jobs entail assembling many things: ventilator circuits, nebulizers, CPAP and BiPAP machines, and oxygen and trach equipment. Sometimes it calls for the inventiveness to arrange for an oxygen patient to go home on high liter flows, or for a ventilator patient to be cared for at home. We educate the patient, their family members as well as other medical professionals on how to assemble, use, disassemble, and clean the equipment and how to troubleshoot related problems.

I contacted a close friend who works at a local inner-city hospital as a respiratory therapist. Since I did not work in acute care during the pandemic, I wanted to know what it was like, especially whether she was provided with the necessary PPE, and what she thinks the hospital and providers have learned since.

A Conversation about her Experience as a Respiratory Therapist During the Pandemic

The following is our conversation about her experience as a respiratory therapist during the pandemic. Remember, this is just one clinician’s opinion based on her own experience. It does not necessarily reflect what has occurred elsewhere, or with someone else, and cannot be generalized.

LC: When was it apparent that there was a crisis brewing?

MB: In December of 2019, we could not figure out what was up with this young patient with Type 1 diabetes. He presented with respiratory failure. We didn’t want to intubate him, so he was put on BiPAP,  which is as per protocol. No matter what settings we put him on, it just would not improve. In fact, it got worse. “Pronation” was unknown at the time, and it was perplexing that no matter what we did, we could not keep his oxygen levels elevated. Eventually, we had to put him on ventilator. But we still couldn’t figure out why he was so ill and not getting any better. No antibiotics seemed to make any difference to his pneumonia and tragically, he passed away. We feel this was our first Covid-19 patient.

LC: Which “co-morbidities” did you see most in the fatal cases of COVID-19?

MB: Mostly we saw hypertension, diabetes, obesity, and obstructive sleep apnea. Most of these individuals were at risk due to these underlying co- morbidities. We had to try different settings on the ventilators to counter the effects of the virus. There were no protocols for treatment, for what this virus was doing to the lungs. We were really pioneering a new way to ventilate and treat these unusual pneumonia patients.

LC: What was the atmosphere at the hospital like during the height of the crisis and how significant a role did our profession play?

MB:  The atmosphere was of course scary, confusing, and tense, especially in the beginning, but throughout the crisis, we developed such camaraderie  and amazing teamwork that no one wanted to go home! I did think about getting the virus myself and I was extremely careful about not bringing it home to my family, but my mission to perform my job outweighed my fear. The respiratory department and the therapists became frontline workers. We maintained the ventilators, we - with the help of the RNs-  did the pronation of the patients, we drew blood gases to see how patients were progressing. We consulted with the MDs and other professionals, and they consulted us on how to adjust settings on equipment. It was teamwork on a truly epic scale!

LC: What do you think the hospital has learned since this event?

MB: First, that we need to expect the “unexpected” and never get complacent. Have sufficient PPE on hand or be able to resource it ASAP if this were to happen again. The worst part for me was seeing patients dying alone. I hope that in the future there will be a way for loved ones to be able to visit the dying patients so they are not alone at the end. It was overwhelming for all of us. It is not only that we had to perform our jobs at a larger and hugely more challenging scale. It is that the toll it took watching the fallout from this pandemic is still immeasurable. But that said, I'd do it all over again. It’s just what we do.

I thank my friend MaryBeth for her insights into what our colleagues in Respiratory were doing to make a difference during this crisis. Remember, a hospital is made up of many more clinicians and caregivers than just doctors and nurses alone. Everyone in the healthcare continuum plays a significant role. From surgery to housekeeping, everyone’s input and dedication mattered during this crisis.

Author Profile:

Laura Castricone (Certified Respiratory Therapist)
My name is Laura Castricone and I am a Certified Respiratory Therapist. I have been practicing in the state of Connecticut since 1992. I have worked in several aspects of respiratory care including sleep medicine, critical care, rehab, and home care. I earned my respiratory certification at Quinnipiac University in Hamden, CT. Prior to becoming an RT, I attended the University of Connecticut pursuing a degree in English but left Uconn in my junior year to work with my father in the restaurant business. I stayed with him for over a dozen years. An education, by the way, that can never be bought! Once I married and had children, the restaurant business no longer fit my lifestyle. When my children were one and two years old, I decided to go back to school and that is where my career in respiratory care began. This career has been very rewarding and I have been blessed to meet some extraordinary people along the way. I grew up in Waterbury, CT, and now live in Litchfield County, CT with my husband and our crazy Jack Russell terrier, Hendrix. My hobbies include antiquing, gardening, writing plays, and painting miniature paintings.

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