Respiratory therapists on the front line of the COVID-19 Pandemic

The Means Report

AUGUSTA, Ga. (WJBF)– We have heard about how the COVID-19 virus attacks the lungs, and respiratory therapists are key in the treatment. We’re finding out what they are seeing on the front lines of treating the illness with Jennifer Anderson from Augusta University Health.

Brad Means: Jennifer, thank you so much for what you and your colleagues are doing. And thanks for taking the time to be with us today.

Jennifer Anderson: You’re very welcome.

Brad Means: Let me ask you this first of all. What does a respiratory therapist do when there’s not a pandemic? Y’all are getting a lot of play these days and let’s just go back to normal times. What’s the typical job like?

Jennifer Anderson: Well a respiratory therapist can function in many capacities. Here at AU, we have both in patient and out patient procedures that we do, a number of things. The majority of the RTs here at AU work in the critical care areas but they also do four therapy. And some of the other specialty areas, we have RT’s that work in the sleep lab, the sleep disorders clinic. We have people who work in the pulmonary function lab and the airway management specialty team for bronchoscopy. So there’s a number of things that we do. We do diagnostic testing for out patients but we also take of patients in the hospital too.

Brad Means: When do you know that it’s time or when does your doctor know that it’s time to see a respiratory therapist. When does the cardio-pulmonary function get to a point where you think, “Okay, we better bring somebody in?”

Jennifer Anderson: Well you know, you can get your cardio-pulmonary function testing in preparation for surgery or as a follow up to a condition that you may have that’s resolving. Or it could be actually to identify a problem that you currently have so that a physician would know better how to treat the patient. It gives them very good diagnostic information but it also gives them information regarding on how well you’re doing and if the care plans working.

Brad Means: What are some signs that you might need some help? Is it simply shortness of breath, is it the inability to take a full breath? When do you know that somethings not right?

Jennifer Anderson: Well, you know, I think that in some cases respiratory problems can develop over a period of time and it’s difficult for you to realize as things are progressing until you get short of breath. Sometimes it could be that you’re just tired or you can’t do as much as you once did. And so I think that any time that you’re concerned about your condition, you should see a physician. And pulmonary function testing with a respiratory therapist is a part of the diagnostic process with your physician. Either family medicine or pulmonologist.

Brad Means: What is a ventilator? I will be honest with you. I hear the term and I say the term all the time and I’ve always just pictured it as a machine that breathes for you. Kind of take me inside of it, tell me how it functions.

Jennifer Anderson: I’ve been in respiratory care now for 47 years so things have developed a great deal since that time. They used to be very simplistic. I had pulmonologist said it’s pretty much good in air and bad air out but there’s so many sophisticated perimeters that you must know to adequately ventilate a patient. Something we take for granted every day, just naturally breathing in and out, is quite complex when you want to try to mimic that with a ventilator. There’s a lot you have to understand about not just the function or technical part of the ventilator but you have to know specifically what’s wrong with your patient and how well you need to match the capabilities of your ventilator with a particular patient.

Brad Means: Just so we can–

Jennifer Anderson: Yeah.

Brad Means: I’m sorry Jennifer, I just was gonna say, just so we can kind of get a picture of what these coronavirus patients are going through. After you intubate a patient and that is to insert a tube down their throat, what happens? Does the machine completely take over? Do you get to help the machine breathe? How’s it work?

Jennifer Anderson: Well, it kind of depends on the patient. We could be just helping them along, they could be awake and aware, maybe just mildly sedated. It could be that they’re completely paralyzed and sedated so the ventilator can do it’s work. It just kind of depends on the patient. Sometimes the patients are intubated early on. With the coronavirus, at first we’re just kind of helping the patient along but depending on how it progresses with that particular patient, you may, in fact, have to take over completely as far as managing every aspect of their breathing whether it’s how many times a minute their breathing, how fast the gas goes into the lungs, how well it empties. There’s a great many perimeters and we have a very sophisticated protocol that we utilize in conjunction with the other disciplinary team members to come up with the right plan for that patient. And then manage the patient.

Brad Means: Well while those protocols are being followed and while the ventilator is assisting the patient, all the while are the person’s respiratory system healing on it’s own while that’s taking place?

Jennifer Anderson: In many cases it does allow the patient to heal. Or say for instance with COVID there’s a part of the lungs that do collapse down. Maybe we’re just trying to keep those open. It could be that they’ve got a lot of fluid on their lungs so then you have to prop them open even more. So pretty much you’re taking everything into consideration, whether it’s a pneumonia with the coronavirus or if it’s just their inability to oxygenate. You have to look at all those aspects with the protocol and mach it up.

Brad Means: Have you had a chance to see a coronavirus patient who’s in the middle of all the things that you’ve described? And if you haven’t, have you heard at least what it’s like for them, how difficult it is for them to breathe at the height of their illness?

Jennifer Anderson: You know, I have not been at the bedside and I have to say we have got the most incredible team that I have ever worked with. And I’ve been here at AU, this time 20 years. And they are in the emergency room, they’re in the ICUs, they’re also with patients as their getting better. But you know, a lot of these patients present very differently. We’re learning a lot about the coronavirus and how it effects the patient’s lungs. And so it can present like somebody’s just mildly short of breath and then there’s other symptoms that they may have that would cause them to be concerned. So yeah, sometimes it is at a point where somebody is, we just have to pretty much intubate them, take over their breathing, sedate them, and allow them to start getting better so we can oxygenate.

Brad Means: What are some of the techniques that you use to help people learn to breathe on their own again or to regain respiratory function after they get off of those machines?

Jennifer Anderson: Well you know, that’s another thing too. It’s not so much getting people set up on a ventilator but it’s actually being very careful and monitoring the patient. Seeing if their ready to come off the ventilator, how strong they are, how well they’re able to oxygenate. And so there’s a great deal of perimeters we measure. We actually could take some measurements with the patient on their own, breathing on their own. And it can be a process. And depending on the condition of the patient it may take several days. Some patients may progress very quickly to extubation but we have to see how well they’re able to move volumes of air in their longs but also how well their oxygenating. So once we see that then we can extubate. But then another process starts. And that’s coaching our patient for deep breathing, making sure they’re clearing their lungs on their own. Watching very carefully to make sure that they don’t have any more setbacks. So it is quite a process.

Brad Means: How long does that take? I know it varies by individual but just generally, when can you release us back into the world to breathe on our own without having to see a pro.

Jennifer Anderson: Well, you know, that’s a another thing too that once they even leave the hospital there’s a lot of follow up that has to happen with their physicians depending on how sick they’ve been. When you’re on a ventilator and you have the ventilator moving air in and out for you and you’re lying in the bed for a period of time, you do get rather weak. We have to build up your strength. So depending on how long you’ve been on the ventilator, it may take a little bit longer for you to regain your strength and get back to where you used to be. But then you’re gonna find these patients come in, see their doctors, and then they’re gonna have to have pulmonary function testing to see how well they’re doing and progressing. And so, you know, the follow up with respiratory could continue on once they go home and come back to see their doctor.

Brad Means: Are people stressed out right now in the respiratory therapy business? Are they having to stay away from their families so they don’t bring anything from the front lines back to their families?

Jennifer Anderson: I feel like we were very well prepared once this started. Everybody volunteered readily. Some people came in from the sleep lab and worked in the COVID units. The same thing with our pediatric therapists. They jumped right in and helped. And I think we felt comfortable because we had a process of protecting ourselves. It was very stressful at first because we were so inundated with so many very, very sick patients. But one thing that we learned is that we jumped right back in, we were helping each other, we stacked up, which we were very lucky to have the staff to do. And I know that I’ve seen people wanna talk more about it from time to time, depending on where they are in the process. But you learn, you know, you wanna take your clothes off in an area where you can clean them. Before going into your home, taking off your shoes. We actually had showers here provided to us for those people who wanted to shower before they went home. So a lot of precautions have been taken to make people feel safe. And I think that’s one thing, people do feel safe.

Brad Means: Have you ever seen anything like this before in your life where your brothers and sisters in the field are saving our communities and really saving our country?

Jennifer Anderson: No, I mean, it’s a first for me. I mean, we have seen things that we were concerned about with SARS and even we stood up an area here during the Ebola concern but really this came on rather quickly. But like I said, we just kind of fell back into a routine where, for instance, we weren’t always able because we had to pull so many therapists into the ICUs and we had to cross train the ventilators that we rented. Our nursing partners actually picked up treatments out on the floor so that we could do that. So it’s been a real great interdisciplinary effort. I can now honestly say no one group was out their on their own but we had everybody on the front line working together.

Brad Means: Well I think I speak for everybody who’s watching this broadcast when I say a huge thank you to you and your colleagues and the respiratory therapy field. Please pass that along with anybody you see, Jennifer. And thank you for everything you do.

Jennifer Anderson: Well thank you, Brad and I’m very proud of the team here and I’m appreciative of the recognition of what they’ve been doing.

Brad Means: Absolutely. All the best to you, come back anytime. Folks that Jennifer Anderson, Jennifer is the director of respiratory therapy at AU Health System and we appreciate her help today for sure. And everybody in the respiratory therapy field.

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