I am a respiratory therapist in a large university hospital. My specialty in neonatal and PEDS.

Ventilators have been in the news a lot and it seems people have many questions/misconceptions about them.

So, AMA!

EDIT - please forgive the typos in the title!

Comments: 271 • Responses: 68  • Date: 

eatmybuttout79 karma

So, after they make these thousands of ventilators, are they going to make thousands more of you guys (RTs) too?

next_rounds_on_me126 karma

Good question! That is the problem and one reason it is so important to keep us safe and healthy!

On any given day I manage 4-7 ventilators in the ICU. That means I am actively monitoring the patient, collaborating with other disciplines, and optimizing the therapy. If I have to manage more than that, quality of care declines for sure. But in what could be a battlefield scenario we will do the best we can.

aeroeax24 karma

Are physicians and nurses able to manage the ventilators on their own?

Merbel39 karma

Yes an ICU doc can manage the vent. That’s one of the most important things they do in the ICU on a daily basis. In our hospital we would round twice a day and make adjustments each time at minimum.

def_135 karma

I have seen several RTs in discussions on reddit imply that they are doing more than doctors during this time due to x, y, z reason. It's pretty sad. We are all doing are best to manage these patients. RTs are a valuable asset but to imply that an icu doctor can't manage a vent without them is ridiculous

possiblycrazy7931 karma

My son was in the ICU for 2 months, more than half that time on a vent. Please be aware that all ICU docs are NOT created equal. The team changed every 7-10 days so I got a load of many different ICU docs. While most were very knowledgeable about vent settings & peep & pressures, etc., most did not know how to actually use the vents. (Keep in mind that all vents are also different. In the ICU my son used a critical care vent, which is different than the home vent that he is using now that he is on the floor.) When they wanted changes, they would have the RT do it. The nurses were also somewhat knowledgeable in the sense that they typically understood how to read the vent, & were able to bump up the oxygen when needed. But as far as changing the settings, 99.9% of the time it is an RT doing it, in my experience. That being said, the RTs who work in the ICU are much better than those who work on other floors, in my experience.

next_rounds_on_me11 karma

This is true! We also need to admit we are talking about different environments in a community hospital versus a university teaching hospital.

When we say docs can run the vent, sure they can operate the basic functionality and make basic changes based on CXR, ABG, and assessment.

But the real magic happens in the labyrinth of sub-menus. We make thing more comfortable, more effective, and safer in the tiny details.

Just yesterday (and this is not rare) I had a doc recommend the exact opposite of what was indicated. I gently corrected him and he learned something!

poptartsatemyfamily17 karma

ICU nurse here.

It varies. Some nurses never bother to learn and just call RT every time the machine alarms. Others have picked up a little bit here and there and aren't afraid to play with the numbers a little. But officially, we receive very little formal training in school or on the job.

next_rounds_on_me9 karma

You are such badasses that I am happy to take the respiratory piece off your plate! Thanks for all you do!

next_rounds_on_me6 karma

Manage? On a basic level probably, once its set up and initial settings are in.

But I think 99% of icu docs and nurses would not be able to set it up and initiate ventilation. Also they would not be able to manage it optimally.

HealerWarrior13 karma

You think intensivists, pulmonologists, and neonatologists can’t manage a vent? lol

Forrian33 karma

I'm a biomed (I fix the medical equipment) and have worked at multiple hospitals. I have met multiple practitioners who work in NICU and ICU who cannot properly operate a ventilator. On multiple occasions I've had to give in-service to entire groups of staff on how to operate them. With the current state of things I am VERY worried...

next_rounds_on_me27 karma

I teach beginning vent classes to residents. I am part of the Fellow education curriculum. I do in service training for pulmonologist to keep them up to snuff on home ventilation strategies and vent management.

I think maybe the disconnect with /u/HealerWarrior is it sounds like they aren’t in a teaching hospital. I’m in a university.

HealerWarrior-26 karma

There’s stupid people everywhere and anecdotal evidence isn’t evidence. A pulmonologist knows far more about vents than RTs.

next_rounds_on_me19 karma

Ok I will remember that next time I am giving and in-service to the pulmonologist.

I am not sure if you mean for your tone to sound so nasty, but it’s coming off poorly.

HealerWarrior-18 karma

“Managing a vent” is more than mashing buttons. It’s knowing what those buttons do and how they effect everything else. Nobody understands pulmonary physiology and ventilatory mechanics than a pulmonologist.

You’re getting bogged down in semantics.

next_rounds_on_me19 karma

Can I ask what you do? You seem very condescending, but also very unaware of how a university treaching ICU works.

Are you suggesting I am "mashing buttons" without knowing what they do and how they affect everything?

I run the ventilators. I coordinate with neonatologists and neonatal NPs. After I make changes to the vent, I tell the docs and they put in the coordinating order.

I have never taken a respiratory order from a pulmonologist. They certainly understand pulmonary physiology better than me, but there is not one at my university who would opt to manage a ventilator over me.

These are not semantics.

Klarthy22 karma

Writing an order for vent settings is much different than getting the machine, gathering the supplies, building the circuit with HME/humidifier/water trap/suction, inputting the settings, and attaching it to the ET tube. I am confident many would struggle without a short training session. The good thing is that you don't need a ventilator in a rush if you have enough people to do short term BVM while people figure out things. (Former RT here)

next_rounds_on_me2 karma

I manage the vent and the docs out in orders to match what I do.

HealerWarrior-3 karma

OP said that MDs couldn’t “manage” a vent optimally. None of what you said has to to with actual vent management. “Gathering supplies” & assembly are not the difficult parts of vent mgmt. I have respect for what RTs do but to act like a pulmonologist can’t manage a vent is stupid.

next_rounds_on_me11 karma

I work in nicu picu at a large university. I have never seen a pulmonologist even attempt to manage a vent. I am sure they could, just not as well as me.

But you seem to have some vested interest in believing pulmonologist are out here running vents, and just as well as the professionals for whom it is their job. Whatevs HealerWarrior. Carry on.

HealerWarrior2 karma

I see pulmonologists, intensivists, cardiac surgeons, anesthesiologists, trauma surgeons, and triple board certified critical care cardiologists managing vents. I appreciate what you do but to think you know more about pulmonary physiology than a physician is ignorant.

These people also know more about ECMO (so there’s my tertiary ivory tower cred you are obviously impressed by).

next_rounds_on_me10 karma

You run ECMO cool!

I have never had a pulmonologist touch a vent of mine.

Anesthesiologist calls ME to come to the OR to run the vent on extremely small or tenuous patients.

It will be a cold day in hell when a cardiac surgeon touches my vent. I have never had one so much as suggest it.

You know it seems we are functioning in two very different environments.

These are stressful times. You have a stressful job. But there is no reason for this AMA to become so contentious. You need a hug, bro?

next_rounds_on_me16 karma

I work with neonatologists and pulmonologist every day. Could they manage a vent? Sure. Just not very well. It’s not what they do. They are really talented and mostly brilliant.

It’s like asking if a really great guitar player can play drums. Sure, they can play. But you’d rather have the drummer on drums.

Your lol is noted. Was that an instruction for me to laugh, or you letting me know you are laughing at me?

def_14 karma

What do you mean by manage the vent? Do you mean you are clinically assessing the patient and changing their settings? Or are you taking about managing the technical features on the vent?

You are quite disingenuous of you are implying doctors can't manage the first part as well as an RT. That is like an radiology tech stating they are better than a radiologist. The technical aspect of getting a proper radiology scan is going to better by a radiology tech but the clinical knowledge and expertise to know how to assess and treat the scan is going to be with the radiologist. Same for you guys.

Source : have worked in an icu before. We managed all the settings.

next_rounds_on_me15 karma

Excellent question!

I am directly assessing the patient and making changes. I also manage the technical features on the vent.

It's unfortunate that you think I am being disingenuous.

You worked in a university teaching hospital ICU? Because that is where I work and we are expected to be the experts on managing all aspects of respiratory care. Just today at work the attending neonatologist came to me and asked for an in-service on the physiology of changing servo pressures on Bunnell HFJV. So I was glad to help him understand the changes in compliance we were seeing in the baby and come up with a tactic to course correct the therapy.

Sure he could manage the vent, just not as well as I could. And he knows it. I know it. You apparently think differently. Okie dokie.

def_15 karma

This was at an icu during my residency.

Perhaps, I may be off base in my assumptions, but I have seen quite a number of RTs in other reddit threads indicating they are "more on the front lines" then other doctors. When I read your comments that is similar to how it comes across. If that is not your intention then okay, I can get behind that you guys play an important role and your knowledge and recommendations play an important part of team care.

I still think that any icu doc worth their weight can manage a vent without an rt.

next_rounds_on_me3 karma

Sure they can manage a vent without us. Just not as well. That is why they come to us with so many questions and seek our advice.

RTs and nurses are hands on the patients all day. Docs come around infrequently. I think it is safe to say we are more on the front lines than docs.

Fofrizzle44 karma

Is it somewhat true that from the cases we’ve seen in the U.S.), once someone is on the vent, they haven’t really gotten off?

next_rounds_on_me60 karma

I have read dismal statistics on success of ventilated patients.

Fofrizzle22 karma

That’s terrible news, but very thankful for all you do. I hope you can be one to see a change in the statistics.

next_rounds_on_me18 karma

Let's hope!

Fofrizzle39 karma

Is your hospital trying to source PPE equipment from unusual places, e.g. Home Depot, etc. ?

next_rounds_on_me76 karma

Yes! We are trying to get PPE from any local source we can! Had 200 N95s donated by a guy who cleans crime scenes...

We are ok now, low on masks and sanitizer but ok. If things get crazy in the next 2 weeks we are in trouble.

ManBearHybrid36 karma

I have a question that's been nagging me for a while. How do ventilators actually help, in a physiological sense? If it was just about delivery of oxygen, then I imagine just a facemask would be enough? Do the patients who need ventilators decline to such a bad state that they need mechanical assistance to breathe? I.e they're unable to physically inhale and exhale for themselves?

next_rounds_on_me158 karma

So the lungs primary job is to exchange oxygen and CO2 at the alveolar level. The alveoli are tiny balloon-like structures at the very end of your bronchial tree. You have millions of them. We call getting oxygen into he bloodstream "oxygenation". We call getting CO2 OUT of the blood stream "ventilation".

Illness or injury can cause these tiny, delicate alveoli not to function. Oxygen or CO2 can reach dangerous levels. Rapid onset of inflammation in the lungs can cause ARDS (acute respiratory distress syndrome). This can be very dangerous. And it is a snowball effect - the worse these numbers get, the less able the lungs are to correct them. Eventually they just cannot.

We intubate with an endotracheal tube and connect the patient to a ventilator. Most strategies from there involve setting a set pressure to fill the lungs (and see what volumes we get) or set a specific volume to deliver to the lungs (and see what pressures we get. Then there is the rate of breaths, the inspiratory time, the I:E ratio, the rise time of each breath, how much pressure we leave in the lungs at the end of each breath, and how much oxygen we deliver. We are basically trying to force air into the lungs in a very specific way so we can make those alveoli function better, without causing harm. We monitor the patient and make changes as necessary.

The ultimate goal of using a ventilator it to keep the patient alive long enough to overcome the disease process.

eoworm21 karma

very nicely explains, thank you- and thank you for the work you are doing!

next_rounds_on_me15 karma

My pleasure!

PhnomPenny12 karma

How does it feel to be on one?

next_rounds_on_me50 karma

I have asked and most people can't remember because a fair amount or sedation involved.

hboxxx32 karma

I've been on one and remember as I was barely coming to as they were about to take me off. It's awful. You start trying to breathe on your own and start fighting the machine. The machine starts beeping like crazy when you do this. You have to consciously force yourself NOT to breathe. This requires constant concentration and it never feels right. The machine is expanding your lungs for you. God forbid you have to cough. The best way I can describe it is feeling a vacuum sucking air directly out of you lungs. Your mouth is drier than you can imagine. Even if there wasn't physiological reasons they need to sedate you the psychological reasons would be enough. Unfortunately they can't just take out the vent and then wake you up. You need to be conscious beforehand. I have what I would describe as light PTSD from it. I don't freak out but what I remember is so vivid it makes me uncomfortable.

After it's out, and the actual removal of the tube going down your throat is actually the only part of this that is less bad than you would imagine, you are helped by a sense of relief. But in my case, and I imagine this is pretty common, the drugs they use to sedate you stay with you for a while. I was floaty for days. For some reason I couldn't sleep for over a week. They gave me paralyzing drugs while on the ventilator and they literally take weeks before being completely gone from your system. I was able to stand up and walk in a few days but you will feel week for a long time. When I first got off the ventilator I didn't have the strength to push the buttons on the TV remote. It took weeks before I could open a bottle of water with my left hand (I'm a righty).

This all happened this past November. I suffered from ARDS from pnuemonia which is what is killing many people with COVID-19. I survived. But my breathing isn't back to where it was before I got sick even now. I'm still improving but the improvement is slowing. I may never be able to work again.

If you read this please stay home. You don't want to go through this, and you don't want to be responsible for someone else going through this.

next_rounds_on_me3 karma

I am sorry for your struggles, friend. Be well and stay home!

pigsinboots36 karma

There was an article in the Atlantic about doctors having to decide which patients to ventilate due to limited ventilators. Is this a discussion that your hospitals have had yet? Do you think we will get to that point in the US? Stay safe!

next_rounds_on_me64 karma

Well it won't be much training. It will be a protocol we are told to follow. It will designed to take the decision making away from us, which I appreciate. They haven't rolled it out and I hope they won't need to.

BarnabyWoods29 karma

Would it be possible to use a CPAP machine as a substitute for a ventilator in the event of a shortage?

next_rounds_on_me57 karma

If a patient needs a ventilator, a CPAP will not do. The CPAP delivers a constant pressure to help keep the lungs open (and your airways if you snore!).

A Bipap could help but is not ideal. It can deliver two different pressures are a rate so it can simulate breathing to a certain degree. But if you need to be intubated and ventilated, only a ventilator will work.

Gamedeals6 karma

I think the question here isn't does a CPAP do the job of a ventilator, but... let me ask a more specific question...

In a worst case scenario, if a ventilator is not available, but a Resmed Autoset 10 is, is it better than nothing and what settings/usage adjustment would you recommend?

next_rounds_on_me25 karma

That’s a CPAP machine right? I think it’s more a sleep apnea machine than anything else, so outside of what I do. But if it’s CPAP, it’s not going to help a patient who need ventilation.

midflinx21 karma

I read some ventilators are "expired" because they're too old, or parts of them are too old. What parts expire, and what's actually likely to happen if they're used anyway?

next_rounds_on_me29 karma

Just like any industry, ventilators are designed to be obsolete at some time, requiring hospitals to buy new fleets every 5-10 years.

The vent is a stand alone unit, but there are many parts that are disposed of or processed between patients. There are expiratory cassettes, filters, flow sensors, all kinds of parts like this. And the are critical to using the vent. You can't use it without them. So if a part is not longer made, you can no longer use that vent.

midflinx6 karma

What happens if you still have all parts to operate a ventilator and use them after the Use By date on those parts?

We have doctors and nurses reusing masks that are supposed to be thrown away. If and when there's a shortage of ventilators, I find it hard to fathom ventilators won't soon be operated with expired but never previously used parts.

next_rounds_on_me23 karma

We don't have any expired parts. But if there was an old vent here and we needed it in a catastrophe, we are going to do what we need to do.

davesoverhere6 karma

Have you guys considered 3D printing the necessary parts?

next_rounds_on_me17 karma

That’s a great idea. Recently (i think it was in italy) someone 3D printed and expiratory valve for a ventilator and was promptly sued by the manufacturer.

But I’d like to think we could in a pinch. But we don’t have a 3D printer.

next_rounds_on_me5 karma

Cool! You know elsewhere in my comment history, not that you would be interested, I said “Why is the name of the company not mentioned anywhere in this article”?

Now I know.

NotTeri18 karma

As far as you know, have any covid-19 patients put on ventilators recovered and been taken off the ventilator?or is it a last chance, let them live a little longer, option?

next_rounds_on_me37 karma

Data is so incomplete now. But I have heard numbers ranging from 20-50% survive once the are placed on the ventilator.

But we haven't had much experience here in America and I am hopeful we will have better sucecss.

NotTeri11 karma

Thank you. It’s horrible that I’m thinking I should just stay home if I have it. It doesn’t seem like a hospital can help much if you get in real trouble with it. Protect yourself

next_rounds_on_me28 karma

There are a lot of ways we can help before we get to a ventilator. If you feel poorly call your doc. They will direct you what to do.

Slommyhouse16 karma

Most likely have covid. Having slight shortness of breath now after 5 days of fever. No fever anymore but respiratory rate is higher and have slight chest tightness. 31 year old male who doesn’t smoke. When would it be time to worry? And what are things one can do at home to improve breathing/lung capacity?

next_rounds_on_me49 karma

Friend, call your doctor. It sounds like you are ill. As much a i would like to, I cannot offer medical advice.

CaptainsLincolnLog3 karma

Do you know of a hotline or video conference thing that people can access if they can’t reach their own doctor? Something like Teladoc, but that’s through my insurer.

next_rounds_on_me15 karma

You should have an insurance card with a number. Or check their website.

MissEssquire13 karma

What’s your general impression of how this affects people (0-70) without underlying medical issues?

Thank you for all your work on the front lines!

next_rounds_on_me16 karma

I can’t really say as we haven’t seen our first case here yet. From what I have seen, most cases are mild. But I don’t think you want to roll the dice!

DarthRatty12 karma

You might be aware that there are thousands of engineers of many disciplines around the world who are trying to self organize to help in this effort in any way we can. An example is helpfulengineering.org.

I wonder what, if anything, you think we might be able to help with. There are now thousands of volunteers, and there may be resources to pursue many different ideas at the same time.

I know there are active projects to fabricate PPE, such as face masks. I have heard that there are people trying to figure out how to fabricate new ventilators and similar equipment. There are other projects underway to connect doctors across the globe.

If someone could provide you with extra ventilators or other equipment like CPAPs it BIPAPs, but you could only have a few features, what features would be most important?

What problems would you like thousands of engineers to work on right now to help you and your colleagues?

Thank you so much for taking the time, and especially for taking care of us all. We're in your debt.

next_rounds_on_me11 karma

Geez I would have to think on that one!! I think the best thing I could do is put you in contact with someone in a position to make impactful decisions. It isnt me. I just manage ventilators on babies.

FastWalkingShortGuy12 karma

I've seen some articles about ventilators being field-modified to support up to eight patients with fairly simple tubing adaptors and extensions.

Is this actually possible, and if so, is it a viable short-term stopgap to alleviate some of the inventory shortfall until manufacturing can ramp up to fill the demand?

next_rounds_on_me27 karma

It would be a very poor choice and only to be considered in the most desperate of situations. I cannot imagine it working very well for very long for many reasons.

boringnamehere9 karma

Boxers or briefs?

next_rounds_on_me29 karma

Commando

I_Invented_Frysauce3 karma

I’m an RT too! Commando in scrubs is definitely not recommended!

next_rounds_on_me2 karma

Don't tell me how to live my life!

:)

I_Invented_Frysauce3 karma

With an attitude like that, you definitely are Respiratory!

next_rounds_on_me2 karma

You get it!

ascooter337 karma

Do you think it’s a good idea for someone who has a history of pneumonia to start nebulizer treatments if they would start to have symptoms of Covid 19 as a precautionary measure?

next_rounds_on_me21 karma

Hey I would ask your doc. I am not going to give medical advice. But hope you are well!

uselubewithcondoms7 karma

Would a person using a bag valve mask do the job of a ventilator?

next_rounds_on_me10 karma

Yes in theory. But over time the ventilation will probably be very ineffective. The best ventilation provides exact pressure or volumes over precise time.

dbxp1 karma

What if you hooked the bag in to an electronic squeezer that could provide the accuracy and endurance required?

next_rounds_on_me2 karma

That is precisely what early ventilators did.

There is a saying we often hear in rounds, “Perfect is the enemy of ‘good enough’”. Your imaginary bag squeezer could work!

kretara8 karma

Yes you can. I have bagged a 24 week baby for 4+ hours. We were unable to ventilate the baby any other way. We had relays of RT’s/Nurses bagging the kid.

While you can bag someone, your hands will get tired fairly quickly. One of the goals of mechanical ventilation is to provide a consistent volume of ‘air’ or consistent pressure (when using pressure ventilation on babies). Hand bagging will provide variable volume/pressure. Not optimal for ventilating a patient.

next_rounds_on_me2 karma

Thanks for your work! It is tremendously important!

MrsKravitz7 karma

There's a doctor in France who retrofitted a ventilator so it can be used by multiple patients at the same time. Is his hack something your facility can copy?

next_rounds_on_me21 karma

They are just adding a couple of t-piece adapters. It could be done but would likely be so ineffective that none would survive.

DISREPUTABLE6 karma

What does a ventilator do essentially, and what medical system does it work in conjunction with? Do blood oxygen levels need to be monitored along side of it? What is the capacity of its effectiveness? And one more thing, what type of pre existing conditions do people have that would require such a device (ventilator)?

next_rounds_on_me15 karma

Basically we use them to move air in and out of the lungs when the patient cannot, or when they are doing it insufficiently. One way we monitor how we are doing and what changes we need to make to the ventilator is by obtaining an arterial or capillary blood gas. We draw a small amount of blood and the sample can be analyzed for any number of values. Primarily we want to know the pH, Co2, oxygen, sodium bicarb, and if there is a base excess or deficit. These values can help us make decisions on how to manage the ventilator.

CaptainsLincolnLog1 karma

The patients have pulse oxes with alarms on them, right? Does everyone on a vent have an A-line?

next_rounds_on_me2 karma

Yes every patient would have a pulse on. This uses a small probe with an infrared light to measure the oxygen being carried in the blood.

Not everyone has an arterial line.

swampcholla5 karma

Would a design form the 50's-70's - something simple without membrane switches, transducers displays, and processors work? Might be faster to source parts and build without extensive safety certs (no software for instance).

I imagine we used to get along without all the bells and whistles but perhaps they were not as precise or required more attention for skilled staff.

next_rounds_on_me9 karma

I’m the hands of a skilled therapists, an old ventilator could be very effective.

Klarthy6 karma

Old ventilators and transport ventilators would both be more effective than letting patients die from respiratory arrest. Ventilators from that time are probably mostly very simple volume-control mechanical ventilation with none-to-poor patient synchronization. I've used the Eagle Impact 754 and LTV 1000 for transport. Both would be suitable for short term use, but probably better suited for post-surgery patients (unrelated to coronavirus and without lung issues).

ICU practitioners will want better ventilation with precision volumes/pressures, patient synchronization, waveforms, measurements for compliance/airway resistance, and potentially more exotic ventilation modes because coronavirus patients are developing Acute Respiratory Distress Syndrome. This is a hard-to-treat condition with high mortality rate even in ideal conditions.

next_rounds_on_me7 karma

We could use those older vents. Would have to break out the calculator and do some actual math! We are spoiled by the vent today doing all the calculations for us.

Norgeroff4 karma

What color is your toothbrush?

next_rounds_on_me14 karma

White with purple and pink bristles.

gixer63 karma

  1. Are you scared?

next_rounds_on_me11 karma

I am a little nervous. I work in the pediatric population but we have already had several suspected (now ruled out) cases. If we get an onslaught of cases in adults, I will be drafted to do in.

FlickerOfBean3 karma

How many of your patients have COVID?

next_rounds_on_me7 karma

None yet!

illimitable13 karma

I've seen videos and mentions of people quickly modifying ventilators to work for multiple patients. In a crisis, is this realistic?

next_rounds_on_me5 karma

Answered elsewhere in this thread. It could work but with critically ill patients I think you would have a real problem delivering the therapy they need. It would be an option in an apocalyptic scenario but honestly not one I would probably opt for.

The_Doct0r_3 karma

How do you think this pandemic will affect your field of RT? Do you think there will be a surge in the demand for RTs after this is all over?

next_rounds_on_me16 karma

I hope that there will be greater interest in the field as a career. It really is a fascinating job! But most people have no idea what we do.

I also hope it means better education and training for us. Our job is so important but the actual education and credentialing doesn't prepare you for the job. If you want to be a bad ass RT (and sorry, we tend to be more irreverent than other disciplines) you have to find a, ICU unit where you can learn. Any ICU worth its salt will take in a hard working RT who wants to learn and make them great!

milolai3 karma

you said you normally run 4-7 of them at a time

in an emergency how many could you do?

next_rounds_on_me11 karma

Maybe 10 more? But not well. Vents need to be monitored and adjustments made as the patient’s status changes. With this many it would be impossible to provide great care, but it could be done in a terrible situation.

Sirflow2 karma

Has your facility stocked the appropriate filters for your vents? The crnas I work with were discussing not having the correct filter, and how if the vent is used without one, it would be unusable on a non COVID pt for at least a month.

Also, do you smoke tobacco/vape? I don't know why, but most RT I've worked with do.

next_rounds_on_me1 karma

We are being told to conserve filters and I think we will be re-using some parts that are post-patient in line. Meaning parts that receive air FROM the patient.

rei_cirith2 karma

Are there filters in ventilators? What keeps the ventilator from being contaminated? Why can a ventilator not be hooked up to multiple people in parallel? Could you theoretically make a giant ventilator with multiple hook-ups?

next_rounds_on_me3 karma

There are many filters built into the ventilator and some that we add.

Most ventilators have some form of expiratory cassette. After the air has entered and left the patient, it goes through the expiratory cassette, through a filter, and is release back into the general air.

When a ventilator is taken off of a patient, this expiratory cassette is removed and sent to central sterile for sterile processing.

You may have seen the multiple hook up scenario mentioned. It would work so poorly that I am not sure I would try it, even in difficult times.

Lungs have varying compliance. That means they react differently to the volumes or pressure we apply. If we are delivering the same pressure to 2 different patients' lungs, and one is less compliant than the other, we will have to either hyperinflate one to get the other to respond, or underinflate one to protect the other from pressure trauma. And that is just one reason its a bad idea except in the most dire scenario.

Stevenwernercs2 karma

Why did the guy that connected some T-splitter fittings get such high praise? Is that not painfully obvious?

next_rounds_on_me2 karma

I think people are looking for hope. It likely would have very poor outcomes for the patients on the dual ventilator.

illimitable12 karma

What is complex about a ventilator? Could a rough replacement be made just for the crisis?

next_rounds_on_me3 karma

Ventilators are very complex. It isn’t just air in and air out. It would be very difficult to creat me a cheap rough replacement.

asadwit2 karma

What do you do to unwind after a hectic day?

next_rounds_on_me3 karma

Family time.

iwasdropped1 karma

Does a sleep apnea machine work in the same way as a ventilator?

next_rounds_on_me1 karma

No a sleep apnea machine is CPAP. That’s is continuous positive airway pressure. It won’t help a person who needs a ventilator.

miketeeeveee1 karma

Were you on a vent as a kid? It seems like a lot of RTs have trach scars.

next_rounds_on_me4 karma

No but my brother was born with TGA and died at 5. I work in the same unit he was in!

Daendrew1 karma

Does having severe sleep apnea that’s treated with a cpap make you high risk for Covid19 complications?

next_rounds_on_me2 karma

Not that I am aware of but I am not a doctor and work with neonates so I wouldnt be the guy to ask.

5giantsandaweenie1 karma

My daughter has had surgery for a gastrostomy tube and umbilical hernia. While in the hospital one of her nurses told me that NICU and PICU were one of the safest places due to constant screenings.

Do you find this true where you’re at? My daughter was a 24’week micropreemie. Thank you for all that you do!

next_rounds_on_me2 karma

I can tell you that there is NOT constant screening in our NICU/PICU. We have limited access to testing and only PUI (patients under investigation) are tested.

I hope your 24 weeker is doing great!

hamsterella1 karma

I’ve seen mentions of patient supination/pronation in regards to ventilation therapy, how does position affect the treatment?

next_rounds_on_me2 karma

Keep in mind that am a neonatal RT so my experience is very different from those that work in adults.

We turn our ventilated babies every 2 hours to help avoid pressure ulcers and to help them with their breathing.

Intubated and vented people are usually sedated so they arent moving very much and they aren’t very good at mobilizing their secretions. Their secretions will pool at the most dependent part of their lungs so we have to move them to keep those areas clear.

There is also a things called V/Q mismatch. V is ventilation, Q is perfusion. In a healthy person, your entire lung is ventilated with air, and perfumed with blood (capillaries that exchange gas at the alveolar level. But with some illnesses you get parts that are not ventilated and parts that are not perfumed. This is very bad because those portions of the lungs are no longer exchanging gas!

Supine, or supination, is simply laying flat on your back. Prone, or pronation, is laying on your belly. These shifts can often help get the V an Q areas more aligned.

In adults, this flip is a big deal requiring a team and is a long process. I am grateful that in the NICU the 1000 gram kids we just flip over. :)

HerroTingTing1 karma

What roles do the nurses and doctors have in managing the ventilators?

next_rounds_on_me1 karma

We collaborate as a team. We round twice a day and vent management is discussed each time and changes and strategies are agreed on. Throughout the day the nurse and I are constantly assessing and making changes to optimize care.

next_rounds_on_me1 karma

We collaborate as a team. We round twice a day and vent management is discussed each time and changes and strategies are agreed on. Throughout the day the nurse and I are constantly assessing and making changes to optimize care.

philzter1 karma

Hello, thank you for your work! Would a cpap, vpap, or bipap provide any help for those who a ventilator isn't available?

next_rounds_on_me1 karma

A bipartisan could offer a small amount of support, but it would be a poor replacement. CPAP will not work.

next_rounds_on_me1 karma

*bipap

Tintila1 karma

My ward is shutting down tomorrow morning and then all staff are getting some rapid training on vents. We are going from coronary care to an ICU ward. Any hints or tips?

next_rounds_on_me1 karma

Thanks you for your service! Your work is vital!

WePwnTheSky1 karma

How long does it take to train an RT and what prerequisite skills/knowledge/qualifications are needed?

Do you think it would be possible to train and mobilize new RTs quickly enough to make a difference since it looks like Covid-19 will be with us into 2021? Even if they can’t attain your level of expertise in that time frame, could they be put to work under supervision of someone like yourself to extend your reach so to speak?

I’m thinking about the number of pilots that were trained in rapid timeframes during World War II. They may not have all been Chuck Yeager’s but it was enough to gain air superiority over Europe which made a massive difference in the outcome of the war.

next_rounds_on_me3 karma

Yes it could be done. But I am not confident that we have the leadership organization for an effort like that.