Terminal extubations are not just another task. Over time they are a mentally draining procedure creating memories that last for years. Yes, COVID-19 highlighted the mental health impacts of performing terminal extubations, but truly, frontline staff have not been properly supported for decades. This session will examine how often the mental health of RTs is impacted by terminal extubations, as well as how long these mental health impacts last. Further, this lecture will provide some low-cost strategies to reduce mental health impacts that require only a small-to-medium amount of work to implement.

Endotracheal intubation is accomplished in a number of care scenarios, from elective intubation in the OR to emergent intubations in the ED and ICU. Who should perform these intubations and what equipment they should use is a topic of some controversy. This presentation will discuss important publications on this topic in the past calendar year.

Ambulatory oxygen therapy is provided to more than a million patients in the U.S. at significant costs. Oxygen therapy is predominantly provided by oxygen concentrators. Liquid oxygen is required by a number of patients with high oxygen demands but is increasingly difficult to obtain. This presentation will review research on ambulatory oxygen over the past year.

The high flow nasal cannula (HFNC) has become a first-line treatment for hypoxemic respiratory failure. During the COVID-19 pandemic HFNC was initially avoided due to concern for infection risk. Later, HFNC became first-line management to prevent endotracheal intubation. HFNC therapy can be guided by the ROX index and has been shown to reduce intubation when coupled with prone positioning. This paper will discuss the studies in the last year on the use of HFNC in COVID-19.

Pulse oximetry is ubiquitous across the health care system. Clinicians rely on SpO2 to monitor therapy, avoid untoward events, and reflect arterial oxygenation. The metrics for describing the accuracy of oximeters can be confusing. The accuracy root mean square is used by the FDA but is not clear to bedside caregivers. Oximeters are not as accurate as clinicians typically believe. Recent evidence has highlighted old knowledge on the impact of skin pigment on accuracy. Similarly, motion and perfusion can alter accuracy. This paper will review publications in the past year that addressed pulse oximetry accuracy and application.

High-flow nasal cannula (HFNC) oxygen therapy has been reported to improve oxygenation and reduce intubation for patients with acute respiratory failure. The clinical indications have been profoundly investigated in the past decade. However, there is no consensus on HFNC flow settings, which may play a key role in the success of HFNC treatment. This lecture will review the physiologic effects of HFNC flow settings for adult and pediatric patients and the current evidence on the optimal flow setting for patients with acute hypoxemic respiratory failure.

High-frequency oscillatory ventilation (HFOV) was once used as a lung-protective strategy in patients with ARDS. However, clinical trials in adults with ARDS demonstrated that HFOV does not improve survival. Does that mean that HFOV should be abandoned, or should clinicians be rethinking the approach? During this lecture, the speaker will discuss new findings that provide insight into the future of HFOV.

The intent of precision medicine is to tailor care to individual patients to maximize benefits and minimize risks. Is it time to take this approach for patients with ARDS? During this lecture, the speaker will review recommendations and unresolved issues about advancing precision medicine for ARDS and how RTs can help move this forward at the bedside.

Weaning a patient from venovenous ECMO (VV-ECMO) can be challenging, and the optimal method remains unknown. During this lecture, the speaker will review approaches and available evidence that guides successful VV-ECMO liberation.

COPD is one of the leading causes of morbidity and mortality around the world. COPD is an old disease receiving a new look with modern science and technology. The global burden of COPD has spurred reassessment of the diagnosis, staging of severity, and research into the genetics. The heterogeneity of COPD has implications for patients’ management and updated recommendations for disease management were proposed in the 2023 GOLD guidelines. One such intervention, pulmonary rehabilitation, is highly effective but only a small percentage of people with COPD who may benefit are referred for rehabilitation. Telerehabilitation may provide access to pulmonary rehabilitation to individuals whose access is limited by geography and socioeconomic factors.

An open lung approach in ARDS is a strategy that involves lung recruitment and subsequent PEEP to reduce ventilator-induced lung injury. The approach is popular, but is it the best way to manage patients with ARDS? Join these two experts as they present data on both sides of the debate.

Awake prone positioning (APP) was used extensively during the COVID-19 pandemic to prevent progression to intubation. While the evidence suggests that APP is helpful in some patients, it is not without challenges. As respiratory therapists move beyond the COVID-19 pandemic, should lessons learned about APP keep it in the ARDS toolbox or leave it in the past?

Hyperoxemia/hyperoxia and its harmful effects have long been debated. The current AARC Clinical Practice Guideline suggests no real benefit of excessive oxygen in acutely ill adults and that normoxia should be targeted. However, is there actual harm associated with hyperoxemia/hyperoxia, and should it be strictly avoided? Join these two experts as they present data on both sides of the debate.