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Q&A with a Respiratory Therapist

Foundation co-founder and super mom, JoeyLynn, is also a pediatric respiratory therapist of 16 years. With current COVID 19 related anxiety running high, she opened up to talk about what a Respiratory Therapist does, as well as answer questions that you may have about life support, ventilators, ventilator settings, oxygen therapy, medication therapy, and artificial airways. Below are some of the questions we received:

Please note that none of the below statements or facts are meant to be interpreted as medical advice, alway contact your medical team with specific questions or health concerns.

Q: What's the difference between being on oxygen and being on a ventilator?

A: We all breathe room air at baseline. Which is approx 21% oxygen in a normal room environment. If you need oxygen, there are a variety of devices that can provide it- from low flow to high flow, nasal cannulas, masks, etc. You still breathe on your own but the device provides oxygen.

If you are on a ventilator it means you need help with ventilation, which is the act of breathing in and out. Oxygen can be provided through the ventilator to provide oxygen to the lungs and organs, but there are also people who just need assistance breathing but do not require oxygen. For these people they would have an oxygen setting of “21%”.

Q: How does the doctor know when a patient can breathe on their own and be taken off the ventilator?

A: We don’t always know for sure which patients will be successful when the tube is taken out (extubation).

There are a few indications that a patient may be ready to attempt taking the tube out. The underlying cause for putting the tube in (intubation) should be resolved. Meaning if they were intubated for infection the infection should be done and cleared up for the most part. If they were intubated for seizures, the seizures should be stopped. Etc.

Then there are a few “readiness tests,” we do a test called a “leak test” to check that there is airflow around the breathing tube. This indicates that there will not be a lot of swelling in the upper airway which could cause problems after the tube is out. There is another muscle strength test that is also sometimes performed to show us that the patient is strong enough to use their muscles to breathe.

Finally you want to make sure that the patient is awake enough to breathe on their own, and that the settings on the ventilator are at the appropriate lower settings.

We then are prepared to take the tube out and support the patient with other devices if needed or nothing at all if they can breathe fine on their own. Sometimes we have to put the tube back in and we are also prepared for that possibility.

Q: I see pictures of patients with either respiratory aid through the mouth and down to the lungs or that there is a cut in the throat under the larynx. What medical conditions do the different methods require?

A: An endotracheal tube that goes into the mouth and down the trachea is placed to connect to the ventilator so that the ventilator can breathe for the patient. There are many conditions that makes ventilation necessary.

Some examples include surgery (sedation needed), respiratory failure for any number of reasons (infection, worsening underlying disease), line placement (sedation), Scans where the patient needs to be still (sedation), and many, many more. We put the tube in when we need to breathe for the patient and control their ventilation to keep them safe.

The neck incision that I believe you are referring to is called a tracheotomy procedure- where a tracheostomy is placed. This is what people refer to as a “trach”. A trach is placed when a patient has been intubated with an endotracheal tube for longer than the medical team would like.

A trach is a more stable, sometimes long term airway. Patients with a trach are able to start moving around after the incision heals. They eventually require less sedation than a person with an endotracheal tube because they have a more stable airway so we can let them move more.

This helps them redistribute the fluid in their body that accumulates from being sedated and still for so long with the endotracheal tube. People with trachs are able to do physical therapy and eventually leave the hospital to hopefully obtain a better quality of life. This is assuming that their underlying condition allows this progress.

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