The AARC’s 61st International Respiratory Convention & Exhibition in Tampa, FL, promises to deliver the know-how you need to succeed on the job. Here’s a sneak peek at five sessions from some of the presenters themselves.
1. Professor’s Rounds: Dueling Experts — Neuromuscular Blockage Should Be Used in Every Patient with Severe ARDS
Richard Kallet, MS, RRT, FAARC
Director of Clinical Research
and Quality Assurance
San Francisco General Hospital
San Francisco, CA
Since the early 1970s there has been an ongoing debate regarding the wisdom of promoting spontaneous breathing efforts early in the course of severe respiratory failure. The basis of this debate has focused on the clinical relevance of opposite problems. On the one hand, sustained periods of passive ventilation result in respiratory muscle deconditioning and weakness. On the other hand, allowing patients to perform high-tension inspiratory work causes structural damage and inflammation resulting in diaphragmatic weakness as well as an increased risk for pulmonary edema and lung collapse through the promotion of patient-ventilator asynchrony.
The use of neuromuscular blocking agents early in the course of moderately severe and severe acute respiratory distress syndrome (ARDS) has been shown to improve survival. However, these agents are also associated with severe sequelae such as acquired, prolonged neuromuscular weakness and ventilator dependence that exposes patients to other hospital-acquired complications. In this debate, Samir Jaber, MD, PhD, will join me in presenting the evidence and considerations necessary for participants to judge the risk/benefit ratio of using pharmacologically induced paralysis in all patients with severe ARDS.
2. How Do I? … Evidence-based Practice
Brian Walsh, MBA, RRT-NPS, FAARC
Boston Children’s Hospital
We hear “evidence-based practice” all around. What is evidence-based practice (EBP), and what does it mean to RTs? EBP is the methodical interdisciplinary integration of what has traditionally been termed the “three-legged stool”: 1) the best available research, 2) clinical expertise and expert opinion, and 3) patient/caregiver perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals
Unfortunately, EBP has different meanings to different practitioners. Some feel that EBP is only an opinion of the evidence, while others feel that it’s only evidence from high-level studies such as randomized control trials. Some will say that it’s malpractice if you don’t follow EBP, while others feel it is cookbook medicine and that patient care should be individualized. Yet, when forced to objectively grade our practices (a procedure used to rank the evidence in #1 above), we find there is a lack of evidence to support much of what we do as respiratory therapists.
This series of lectures will help the participant answer some of the more difficult questions we face today in neonatal and pediatric respiratory care. The experienced interdisciplinary panel will help step us through how to evaluate the current EBP on the four hot topics we face: noninvasive ventilation versus intubation, setting up the ventilator, deciding when to move beyond conventional ventilation, and sedating the ventilated patient.
3. Tobacco Cessation
Sarah M. Varekojis, PhD, RRT
Assistant Professor and Director
of Clinical Education Respiratory
Ohio State University
The “2014 Surgeon General’s Report: the Health Consequences of Smoking” was very clear that while we have made progress, there is still a long way to go to end the tobacco epidemic. In our role as respiratory therapists, we are in a unique position to make a significant difference in both the treatment of tobacco dependence and in educating our patients about emerging tobacco products. As cardiopulmonary specialists, we are experts in the treatment of tobacco-related diseases; and we have an opportunity to help these patients make the choice to improve their health now and in the future by quitting.
For some, however, smoking cessation seems like a mystery — these therapists are concerned about how to approach patients and what to say. The good news is that there are great resources for smoking cessation that are evidence-based and shown to be effective, and we can use these resources when we approach patients. This presentation will provide information on how to make your smoking-cessation efforts with patients successful.
For others, the mystery is centered on all of the different forms of tobacco available today. We will address several emerging forms of tobacco to prepare the RT to address the use of these products with their patients. For many, electronic nicotine delivery systems — commonly known as e-cigarettes — are especially confusing. RTs are often asked by patients if they are safe to use and if they are effective as a smoking-cessation strategy. The symposium will include an exciting pro/con debate on e-cigarettes that will provide you with current information to give to your patients and help you determine what advice you can offer to them.
We hope that at the end of the symposium, you will have increased confidence in your ability to have the smoking-cessation conversation, feel better prepared to address patient questions about successful quit strategies and new tobacco-related products, and are ready to incorporate the knowledge and skills into your practice.
4. Connecting the Dots from Inpatient to Outpatient Chronic Disease Management
Charley Starnes, RRT,
Supervisor of Pulmonary
Healthcare System Pineville
Patients with chronic respiratory disease are often complex due to multiple co-morbidities, numerous medications, and, often, different providers treating the same issue. During a hospital admission, respiratory medications can differ from the patient’s home regimen; and without proper explanation and education, this can cause confusion upon discharge.
Utilized as a navigator for this patient population, the respiratory therapist can be essential for success in patient self-management, which can help to decrease hospital readmissions. The addition of an RT to the outpatient realm adds another benefit. This link in the continuum of care helps to bridge the communication gap and facilitates coordination of resources, such as medication reconciliation, medical equipment acquisition and compliance, and assistance. This connection should begin during the patient’s hospital admission and follow throughout the continuum of care to provide the best pathway to self-management and success.
It is essential to provide patients with information and resources that are easy to understand and are standardized from one treatment area to the next. We, as respiratory therapists, are in the best position to advocate for these patients because we are the pulmonary experts at the bedside day in and day out. We are educated in the various chronic pulmonary diseases, their progression, and their management. Providing a consistent message, from that first patient encounter to the discharge follow-up appointment, helps to ensure that the patient fully understands the regimen. It allows patients time to process the information given, ask questions, and master the skills needed. It also empowers them to actively participate in their care plan.
5. Critical Care Case Reports: Putting the Evidence to Practice,
an Interactive Exercise
Keith Lamb, BS, RRT-ACCS
Adult Critical Care
and Extracorporeal Life
Support Unity Point
Des Moines, IA
Critical care is the “bread and butter” of our profession and one of the things we do best. This symposium covering a series of case reports will focus on common critical-care scenarios and will be presented by RT professionals with vast experience in taking care of these types of patients. Discussion will involve the panel of speakers and the audience in real-time participation.
The speakers will begin by zeroing in on four scenarios: 1) severe asthma in the emergency department, 2) traumatic brain injury (TBI), 3) acute exacerbation of COPD, and 4) drug overdose. Each topic will then be discussed among the panel and with the participating audience. Here is just a brief overview of the questions we’ll raise:
Severe asthma in the ED: You have a patient in the ED whom you cannot ventilate. Acute asthma and severe bronchospasm? Anesthetic gasses? What do you do? What are your options? Can you treat this patient effectively in the ED?
Traumatic brain injury: When is TBI severe enough to warrant empiric airway protection? When, if ever, do you hyperventilate? Do we need to have an increased awareness of ventilator-associated pneumonia?
Acute COPD: When do you use noninvasive positive pressure ventilation (NIPPV)? When do you intubate? When do you extubate? When do you recommend tracheostomy?
Drug overdose: Can the process be reversed without mechanical airway protection? Are some drugs more likely to cause respiratory failure? Can you use NIPPV?
These topics will provide a great overview of critical care scenarios and generate excellent discussion. Don’t miss out on this opportunity to tell the panel what YOU would do. Everyone should learn something.
This article was originally printed in the September 2015 AARC Times magazine.
Want more sneak peek details about Congress? Read these additional stories in the AARC Times digimag:
• Tampa Bay Insider: August Issue
• AARC Congress Advance Program
• Sputum Bowl: Where Hard Questions Meet High-Spirited Fun
• Keynote Speaker: Patrick Reynolds, Leading Anti-smoking Activist
• Tampa Bay Insider: September Issue