When patients with COVID-19 and other respiratory illnesses struggle to breathe, they rely on respiratory therapists to provide much of the support they need. In this podcast, Einstein Healthcare Network respiratory therapist Noreen McIntyre, RRT, talks with Perspectives’ Fantini about the role of these health professionals.
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Noreen McIntyre: We are definitely in a position of high risk. When these patients come in requiring any type of oxygen device, it does put us directly in content with the patient while we’re putting on these devices.
Bill Fantini: Everyone knows that throughout the coronavirus pandemic doctors and nurses have been putting themselves on the line to care for critically ill patients with COVID-19. The crucial role of respiratory therapists in treating this illness, which attacks the lungs and breathing, is less often recognized. To learn more about this little understood specialty, we spoke with Noreen McIntyre for Einstein Perspectives. MacIntyre is a registered respiratory therapist who is treating patients with breathing problems at Einstein Medical Center Philadelphia.
Fantini: Well, I’d like to thank you for joining us, Noreen, and the first question I’d like to ask is in general what is the role of a respiratory therapist?
McIntyre: What we do is work within teams within the hospital. We are part of the critical care team. For example, when there is a code team, we are part of that team to maintain the airway. We are also part of a team known as a rapid response team, which is called to the bedside for any patients that might have experienced an acute change in any type of situation, just to monitor their respiratory status, to make sure that they’re safe, and if they should need any further intervention, we would step in and provide any care needed. And we also are part of the trauma team for any emergencies that should come into the emergency room, to make sure that if a patient can’t maintain or protect their own airway, again that’s something that we would step in and help them with. And we are also part of the NICU team, which stands for a neonatal intensive care unit. Again for the same thing for premature babies or term babies that are born that should need any type of respiratory support, we would step in and provide that for them.
Fantini: What kind of training or education is needed for one to do this kind of work?
McIntyre: I’ve been in the field for approximately 22 years, so when I started it was an associate’s degree program and there were bachelor programs out there, but there wasn’t that many. Going back, I guess about 10 years, it had definitely moved in the direction preferred for a bachelor’s degree. I went to Community College of Philadelphia, which was a two-year program, and I hold a registry certification as well as a registered pulmonary function certification, and working in a hospital setting, it is actually nice because most institutions do provide some sort of monetary support to encourage staff to go back to get their bachelor’s degree, which Einstein does as well.
Fantini: What kind of conditions do respiratory therapists treat?
McIntyre: A wide range of conditions, mostly focusing on the respiratory system if there was some type of compromise. Something most people would be familiar with would be asthma, pneumonia or a disease process called COPD, which is chronic obstructive pulmonary disease. However, we are involved in the treatment of other disease processes as well. Your organ system does work together, so if there is an issue with the brain, with the heart, with the kidneys, or with the lungs, it can all have an effect on your body’s ability to breathe or to ventilate themselves. So if any of those organs have an issue, we would have to step in. It could be something as simple as just providing oxygen to give respiratory support, or as to the extreme of needing a ventilator.
Fantini: We’re all hearing lots about respiratory problems with the current pandemic. What’s your role in treating those problems?
McIntyre: For patients that are coming in that are suspected of COVID, or that we know that are positive for COVID, one of the biggest things that we are trying to do hospital-wide is placed them in a negative pressure room. That’s something that is decreasing the spread of the virus, not only to other patients, but to hospital staff as well. Once we can get that situated, we’re monitoring the patient’s respiratory status. That being their ability to breathe, how hard they’re working to breathe, because that plays a role in what we can do and provide for that patient care-wise. If someone is working really hard to breathe and they’re getting tired, we can step in with something again as small as oxygen, to bring their oxygen levels up, or to the most extreme with the ventilator for those patients who are so tired or just not able to provide themselves with enough oxygen and get rid of their carbon dioxide.
Fantini: Tell us a little about the treatments and equipment that you use?
McIntyre: For COVID-specific patients, or respiratory in general, it is similar equipment, the most basic being oxygen therapy. Most people are familiar with that. It’s just the nasal cannula that sits within the nose and can provide a small amount of oxygen. We can escalate care to other equipment that’s known as a high-flow nasal cannula or also a Vapotherm. These devices are much more specific. They can provide flows of up to 60 liters, and also provide precise amount of oxygen levels, that provide pressure in helping to keep the lung tissue open to help the patient oxygenate better and get rid of their carbon dioxide. If a patient should require an escalated level of care, we also use machines called BiPAP machines or C-PAP. This is a machine that would help a patient who was feeling very tired to take a deep breath so they get an adequate volume of air into their lungs, and also giving a specific amount of oxygen, and also providing a back pressure to help stabilize the lungs so they again can get the most amount of oxygen that we’re giving them, and be able to get rid of the carbon dioxide in their lungs. And the next level of escalated care from there with the patient who’s still tired and unable to ventilate themselves, at that point, we can step in with a breathing tube and a ventilator to let their body completely rest and do the work for them.
Fantini: A big topic in the news is the ventilator supplies. Do most people in the hospital with COVID-19 need a ventilator to get better?
McIntyre: From what we’re seeing, no. It’s hard from a respiratory therapy standpoint because the patient population that we’re seeing are the ones that most likely are requiring a higher level of care. There are patients that are within the hospital that are requiring minimal support, or there’s patients who are being quarantined at home with symptoms, and are able to manage themselves. From our standpoint, our focus is on those patients that are critically ill, or having severe symptoms, where we do in fact have to step in with these high-flow oxygen devices, BiPAP or a ventilator.
Fantini: As a respiratory therapist, does that put you at a high risk of infection on the job?
McIntyre: Yes, we are definitely in a position of high risk. Keep in mind when these patients do come in, and they’re requiring any type of oxygen device, it places us directly within the region of their face, and this disease they’re saying is airborne or droplet. So it does put us directly in contact with the patient and almost face to face with the patient while we’re putting on these devices. Also, when breathing tubes are placed, we again are right there at the face of the patient, and when we’re removing breathing tubes for when they do get better, again, we are face to face with that patient at their bedside. And even when we’re setting up the equipment, it’s not something that you can just do and walk out of the room. You have to set up a patient what might be considered appropriate settings for them at that moment, but you also have to stay with them for a little while and make sure that they feel comfortable, make any adjustments that might be needed, which also does increase our exposure time to the virus.
That being said, we also do take appropriate precautions. Wearing gloves, we’re wearing gowns, we’re wearing N95 masks which filter inspiratory and expiratory air, and when we know that we are going to be in close contact with a patient where there might be any type of aerosol spray or potential contact with mucus, we are also wearing a face shield over all of that equipment just as added protection.
Fantini: What else would you like to tell people about respiratory therapy?
McIntyre: I think it’s a very enjoyable job. It is high-paced. You do get to work with the most critically ill patients, but it’s also rewarding when you see that these patients improve and get to go home. I think that our profession, we are placed on most teams within the hospital, particularly when there’s an emergency, like the trauma team, the NICU team, the Intensive Care Unit team, and rapid response team. So we are definitely well-respected within the hospital and that’s a good feeling.
Fantini: Well, I want to thank you so much for joining us today and passing along this information. It’s been a pleasure speaking with you.
That was Noreen McIntyre, a registered respiratory therapist who is treating patients with breathing problems at Einstein Philadelphia. Be sure to check back at our website, EinsteinPerspectives.com, to hear conversations on a host of other medical issues. For Einstein Perspectives, I’m Bill Fantini. Thanks for listening.