54th Congress

Congress Gazette

Monday, December 15, 2008

ARDSNet takes center stage at Kittredge Lecture

Timothy McDonald

Richard Kallet

Few clinical trials have had as big an impact on respiratory care in the ICU as the National Institutes of Health’s Adult Respiratory Distress Syndrome Clinical Trials Network—known by most of us simply as “ARDSNet.” But while its findings on low tidal volume have been hailed as the first major breakthrough in the treatment of ARDS, the network itself has been embroiled in controversy.

ARDSNet member Richard M. Kallet, MS, RRT, FAARC, will provide Congress-goers with an insider’s look at the network and its impact on critical care medicine this morning in the 24th Phil Kittredge Memorial Lecture. Attendees are awaiting this great opportunity to hear about this provocative network from someone who experienced it from the inside out.

YourLungHealth Program heads out into the community

As respiratory professionals learn the latest about respiratory care at the Congress, local citizens will be getting an education in lung health as well, thanks to the AARC’s annual YourLungHealth Consumer Program.

This year’s event will take place this afternoon at the First AME Church in Los Angeles, which serves low income families in the area. “We’ll have respiratory therapists educating patients, who will receive one-on-one advice and information about their chronic respiratory conditions and the medications and devices they use to treat them,” says AARC COO Tom Kallstrom, BS, RRT, AE-C, FAARC. “It’s our way of giving back to the community and making sure people in underserved neighborhoods have the opportunity to learn more about lung health from the lung health experts—RTs.”

Peak Performance USA

Timothy McDonald

Congress-goers will be learning more about a new community service project from the AARC this morning at 11:30 in the AARC Information Center in the Exhibit Hall, as Tom Kallstrom, AARC COO, provides additional details on the new Peak Performance USA, a national asthma awareness/school health program now online at www.PeakPerformanceUSA.info. Attendees who come by will also be treated to free ice cream.

AARC President Myers outlines 2009–2010 goals

Timothy McDonald

Timothy Myers

Timothy R. Myers, BS, RRT-NPS, plans to get back to basics during his term as AARC president. In an address delivered yesterday during the AARC Business Meeting, he outlined his goals for his term in office, emphasizing the need to focus on ongoing programs and projects aimed at supporting the core values of the Association.

“Frequently in the hustle and bustle of daily activities or the changing health care landscape, organizations expand their resources and ultimately lose their focus and/or effectiveness,” said the incoming AARC president. “It is during those times that an organization must utilize its Mission/Vision Statement as a roadmap for decisions and its ultimate destination.”

Myers’ 2009–2010 goals include:

  1. Continue to develop and execute strategies that will increase membership and participation in the AARC to promote professional excellence, advance the science and practice of respiratory care, and advocate for the respiratory care community.
  2. Promote patient access to respiratory therapists as medically necessary in all care settings through appropriate vehicles at local, regional, and national venues.
  3. Continue to advance our international presence through activities designed to address issues affecting educational, medical, and professional trends in the global respiratory care community.
  4. Identify the clinical/non-clinical skills, attributes, and characteristics of the “Respiratory Therapist for 2015 and Beyond” based on the expected needs of respiratory care patients, the profession, and the evolving health care system.
  5. Develop a leadership and mentoring institute (process) to promote the advancement and growth of respiratory research, management skill sets, and education curriculums and practices to meet the future demands of the profession.
  6. Promote the access of quality continuing education to develop and enhance the skill base of current clinicians to meet the future needs of our profession.
  7. Maintain and expand relevant communication and alliances with key allies and organizations within our communities of interest.

Open Forum 2009

To submit abstracts for the Open Forum at the 2009 Congress in San Antonio, just take the “Easy Street” at http://aarc2009.abstractcentral.com/. Deadline is June 15.

Request for proposals

To submit a Request for Proposals for sessions at the 2009 Congress in San Antonio, log on to http://aarc2009.abstractcentral.com/. Deadline is Jan. 15.

Asthma course coming to your computer

For the past 7 years, the AARC’s traveling asthma educator course has helped thousands of clinicians prepare for and pass the AE-C exam. In fact, the pass rate for those who have taken our prep course is 88%.
In 2009 the Association will harness the power of the Internet to deliver the course right to your computer screen. AE-C Online will feature video presentations by many of the same top-notch lecturers who presented the live version, along with a 100-question practice exam and feedback on areas the learner needs to address to pass the test.

“We get requests from all over the country for this popular course,” says AARC COO Tom Kallstrom, BS, RRT, AE-C, FAARC. “AE-C Online will be able to now ensure everyone has access to this state-of-the-art prep course.”

Coming Soon! Human Resources Survey 2009

The AARC will be surveying respiratory therapists and their employers to gain information about supply and demand for respiratory therapists, their compensation, and other workforce issues. Look for results in the spring of 2009.

Continuing education in 2009

2009 will see a wealth of continuing education opportunities for AARC members. The Association is planning another 8-session Professor’s Rounds series and is scheduled to offer between 18 and 20 of its popular webcasts over the course of the year.

2008 Vent 5K winners announced

The second annual Ventilator 5K events took place all over the country earlier this year, and now the results are in.

  • 1st Place: Weber State University, Ogden, UT, repeat as winners again this year and will receive an LTV 1150 ventilator donated by Cardinal Health.
  • 2nd Place: St. Paul College Respiratory Therapy Program, St. Paul, MN, will be hosted by the team at a St. Paul Saints baseball game.
  • 3rd Place: University of Minnesota/Mayo Clinic Respiratory Therapy Program, Rochester, MN, will enjoy a group outing at the Minnesota Ice Hawks hockey game.

This fun event is perfect for National Respiratory Care Week but can be hosted anytime of the year to raise awareness of the respiratory care profession and funds for local lung health projects at the same time. To learn more, visit www.arcfoundation.org and click on “Vent 5K.” Then start planning your event for 2009.

Respiratory Care Education Annual call for papers

The AARC will publish Volume 18 of the Respiratory Care Education Annual in the spring of 2009, and the Education Section invites educators to submit papers for consideration. Deadline for submission is Feb. 15, 2009. Papers should be approximately 6 to 10 pages in length with abstracts less than 120 words. For more information on style and format, contact Bill Dubbs at dubbs@aarc.org.

Covidien Sputum Bowl® finals tonight

Teams (both traditional and student) from our state societies have been competing this week, but it all comes to a head this evening as the top four teams in each division dual to the finish for their championships.

The Student Sputum Bowl final four are from Colorado, Texas, Michigan, and North Carolina. We have a lot of students attending the Congress this year, and we especially invite them to come tonight and see what Sputum Bowl competition is all about… and to cheer on the winner.

Then the National Sputum Bowl championship will be decided as four teams from Michigan, California, Pennsylvania, and Minnesota either keep you on the edge of your seats or jumping to your feet as the excitement builds.

A fun half-time show will feature comedy magician Chris Blackmore, one of the most requested corporate entertainers by Fortune 500 companies. Bowl organizers will also be paying special tribute to Jim Fenstermaker, RRT, who is wrapping up his 30-year tenure as Sputum Bowl chair this year. Plus, the historic Sputum Bowl will be raffled off again by the ARCF, and winners of the AARC PAC Raffle will be announced.

Roving Reporter:
CPT coding for respiratory care services

by George Gaebler, MSEd, RRT, FAARC

Coding for purposes of payment in health care must be thought of as a language just like any other language, said Susan Rinaldo-Gallo, MEd, RRT, in a talk delivered yesterday.

According to Rinaldo-Gallo, who works at Duke University Health System in Durham, NC, there is a process by which ICD-9 codes are provided by the Centers for Medicare and Medicaid Services (CMS) to describe patient diagnosis at the time of treatment. These codes are then coupled with either CPT or HCPCS codes that describe the treatment method and/or device that is used by the respiratory therapist in the course of treatment. The American Medical Association (AMA) creates and publishes the CPT codes. The addition of revenue codes by CMS completes the circle by which payments may occur.

Respiratory care was not well known at the time that Medicare and Medicaid were formed in 1965 and 1966. Therefore, our profession was not included in the legislation as a provider of care capable of charging separately. Our services are incident to a physician, with requirement for some level of supervision.

On the inpatient side, where most CPT coding occurs, we do charges for corporate compliance; however, they are not sent to CMS because our services are part of the inpatient DRG. For outpatients, where Medicare Part B governs payment, many of the HCPCS codes are used. In this case we must have some level of supervision, such as in a clinic. In all cases, charging passed through to a carrier such as CMS, or for corporate compliance with DRGs, is a process that provides productivity and benchmarking capability to compare your workplace to others.

While the AMA may grant a CPT code, that is no guarantee that CMS will fund the codes with payment, noted Rinaldo-Gallo. There must be a national coverage decision (NCD) on the part of the Medicare Administrative Contractors for this to happen. If there is not an NCD, there may be coverage if a local coverage decision is made. This was the problem that existed with pulmonary rehabilitation. There was no NCD, so the payment was spotty at best. With the passage of legislation this past July, there will be an NCD to govern national payment beginning in January of 2010. This legislation was brought about through the work of the AARC and many co-sponsoring entities.

Roving Reporter:
Why do respiratory therapists pursue baccalaureate degrees?

by Lynda T. Goodfellow, EdD, RRT

Ellen A. Becker, PhD, RRT-NPS, AE-C, associate professor of respiratory care at Long Island University in Brooklyn, NY, began her presentation by exploring the value of the baccalaureate degree in respiratory care. From there, she described the results of interviews she conducted with 12 respiratory therapists to ask why they chose to go back to school to complete their baccalaureate degrees.

Dr. Becker discovered that these therapists realized that many benefits could be gained by earning a higher degree, such as enhanced communication skills and greater problem-solving abilities. They also cited personal reasons, which included greater opportunities and advanced promotions.

Dr. Becker provided qualitative data from her interviews to expand on specific ideals or threads realized from the completion of a baccalaureate degree. One of these threads can be classified as professional reasons for pursuing a baccalaureate degree. Other threads included going back to school for personal reasons, or because it was required for their job or for a future career direction they wanted to explore. Gaining a sense of accomplishment, greater choices in jobs, increased marketability, and to be competitive for teaching positions were noted as well.

According to Dr. Becker, pursing a baccalaureate degree can be seen as a journey. Throughout this journey one must decide which degree, which academic program, and what major to pursue, as well as the institution that best fits the individual. Several therapists she interviewed cautioned that degrees should be from credible programs. Several factors must be examined as a prospective student navigates this process. The location of the course offerings, course schedule, and structure of the course (traditional or online; amount of group work required) are other factors to be considered.

Finally, Dr. Becker outlined the advice she gleaned from the interviewees, which might be helpful for others considering going back to school for their baccalaureate degree. Specifically, the therapists told her: If this is what you want to do, do not let anyone tell you that you cannot or should not do it.

Roving Reporter:
PEEP: Bringing the evidence to the bedside

by Roger L. Berg, PhD, RRT-NPS

Presenters Ira Cheifetz, MD, FAARC, from Duke Children’s Hospital in Durham, NC, and Dean Hess, PhD, RRT, FAARC, from Massachusetts General Hospital in Boston, employed an interactive, audience response, case-based approach with an in-depth review of the medical literature to address this topic.

For several decades, they said, PEEP has been a controversial subject and a topic of challenge on the proper amount of PEEP to apply and how to set PEEP for our patients with acute lung injury. More often than not, our opinions will differ from colleagues in our own departments, as well as from one physician to another. Their lecture was designed to bring together the available scientific research as well as evidenced-based studies to try to answer the question: Is your practice of using PEEP supported by the medical literature?

Three different studies were reviewed in-depth, all using low Vt of 6 mL/PBW, but using various levels of PEEP, from moderate to high. Each of these studies concluded that there was no difference in mortality. However, there was greater lung alveoli recruitment with an increase in PEEP, along with an increase in lung compliance, decrease in dead space, and increase in oxygenation.

Dr. Hess recommended using a PEEP trial to see if PEEP makes a difference in your patients. Are there alveoli that we can recruit? If the patient has consolidation, then the answer is no, but if the patient has telecasts the answer is yes.

Their conclusions:

  • Zero PEEP is harmful.
  • 8-15 cm/H2O PEEP is appropriate for most patients.
  • >20 cm/H2O PEEP is seldom needed.
  • There is no evidence of better outcomes by using a precise PEEP.
  • There is no perfect solution.
  • “Optimal” PEEP is difficult to define; use the “BEST” PEEP for each patient.
  • The purpose of PEEP is to decrease the risk of lung injury.
  • Increase alveoli recruitment, increase lung compliance, increase oxygenation, decrease dead space, and ensure patient comfort and hemodynamics.

35th Donald F. Egan Memorial Lecture: The cardiorespiratory physiology of dinosaurs

by David J. Pierson, MD, FAARC

Dinosaurs have intrigued us for generations, and as health care professionals whose daily practice relies heavily on an understanding of physiology, it is natural for us to wonder about how the largest creatures ever to walk the earth actually worked. There may be no dinosaurs around for us to examine in the laboratory, but quite a lot can be figured out from what we now know about their shapes, their dimensions, the environments in which they lived, and other evidence in the fossil record, in combination with our understanding about the physiology of their living relatives.

Two aspects of dinosaur physiology that have received attention in the scientific literature are what their blood pressures were and how their respiratory systems were put together. The brains of the tallest long-necked dinosaurs would have been 40 feet above the ground if their necks were held erect. This would mean an arterial blood pressure leaving the heart of nearly 1000 mm Hg in order to deliver blood to those brains. Is this possible? How would their hearts have had to be designed, and how big would those hearts have had to be? What other, alternative possible designs are there for the circulatory systems of these largest dinosaurs?

And how did they breathe? Some dinosaurs had necks 35 feet long. A respiratory system with the lungs in the chest and the nostrils in the head would seem to require a trachea so long that either its airway resistance or its dead space—or both—would be so excessive that breathing might be impossible. However, the largest dinosaurs may not have had lungs like ours, but rather a completely different design—like those of birds. We now know that birds are the descendents of dinosaurs, and their unique respiratory system may be the key to understanding how such colossal creatures could have survived.