Respiratory Care

In Japan, expiratory rib cage compression (a chest physiotherapy technique) is frequently used with mechanically ventilated patients. It has not been determined whether rib cage compression combined with endotracheal suctioning improves oxygenation, ventilation, and mucus clearance. We evaluated the effects of rib cage compression with and without endotracheal suctioning on P_aO2 , P_aCO2 , dynamic compliance of the respiratory system (C_RS), and mucus clearance in rabbits with induced atelectasis.

Anesthetized adult rabbits had an 18-gauge catheter placed into the airway, together with a tracheal tube via tracheostoma, and were mechanically ventilated. To create atelectasis, artificial mucus was infused into the airway via the catheter. Each rabbit was randomly assigned to one of 4 groups (n = 7 in each): (1) control, (2) received endotracheal suctioning alone, (3) received rib cage compression alone, and (4) received both rib cage compression and endotracheal suctioning. After these interventions, for 30 min, each animal was placed supine without intervention for 120 min.

In the groups that received rib cage compression, oxygenation, ventilation, and C_RS were significantly worse than the groups that did not receive rib cage compression (p < 0.05). Endotracheal suctioning with and without rib cage compression did not improve oxygenation, C_RS, or mucus clearance. There were no significant differences in the weight of aspirated artificial mucus between the groups, with or without rib cage compression.

In mechanically ventilated rabbits that had induced atelectasis, neither rib cage compression alone nor rib cage compression combined with endotracheal suctioning improved oxygenation, ventilation, C_RS, or mucus clearance. Alveolar and airway collapse was probably exacerbated by rib cage compression.

The traditional nasal cannula with bubble humidifier is limited to a maximum flow of 6 L/min to minimize the risk of complications. We conducted a bench study of 2 new Food and Drug Administration-approved nasal cannula/humidifier products designed to deliver at flows > 6 L/min.

Using a digital psychrometer we measured the relative humidity and temperature of delivered gas from each device, at 5 L/min increments over the specified functional high-flow range.

The Salter Labs unit achieved 72.5-78.7% relative humidity (5-15 L/min range) at ambient temperature (21-23°C). The Vapotherm device achieved 99.9% relative humidity at a temperature setting of 37°C (5-40 L/min).

Both devices meet minimum humidification standards and offer practical new treatment options. The patient-selection criteria are primarily the severity of the patient's condition and cost.

Respiratory care is expensive and time-intensive, inappropriate care wastes resources, and failure to provide necessary and appropriate respiratory care may adversely affect patient outcomes.

To determine the appropriateness of basic respiratory care delivered at a 450-bed Veterans Affairs hospital during a 3-month interval.

We determined (1) the percentage of delivered respiratory care that was not indicated (based on standardized clinical practice guidelines), (2) the percentage of respiratory care that was indicated but not ordered (based on standardized clinical practice guidelines), and (3) the labor cost and potential savings of protocol-based respiratory care at our hospital. We selected 5 assessment days, occurring at 2-week intervals. All patients who received basic respiratory care underwent a complete respiratory care assessment, including medical records review, patient interview, physical assessment, and measurement of blood oxygen saturation (via pulse oximetry) and inspiratory capacity. Intensive care patients were excluded from the study. The assessment instrument provided a standardized format based on American Association for Respiratory Care clinical practice guidelines.

We assessed 75 patients. A mean of 24.8% of the delivered respiratory therapies reviewed were not indicated. The percentages of ordered but not indicated therapies were: oxygen 17.7%; all categories of aerosolized medications (bronchodilators, mucolytics, anti-inflammatory agents) 32.4%; chest physiotherapy 37.5%; lung expansion therapy 7.7%. A mean of 11.8% of the patients assessed were not receiving respiratory care that was indicated. The percentages of indicated but not ordered therapies were: oxygen 5.3%; bronchodilator 5.3%; lung expansion therapy 36%.

A mean of 24.8% of the basic respiratory care procedures delivered were not indicated and 11.8% of patients were not receiving care that was indicated. Inappropriate utilization of respiratory care services may increase costs and adversely affect morbidity, mortality, and duration of stay. We believe that implementation of respiratory care assessment protocols based on nationally accepted clinical practice guidelines can reduce unnecessary care, optimize care delivered, and may reduce costs and improve outcomes.

Studies of non-health-care work environments indicate that non-managerial employee job satisfaction is higher in companies that use participative (as opposed to autocratic) decision making. It has not been determined whether managerial decision-making style influences job satisfaction among respiratory therapists (RTs) and which managerial decision-making style RTs prefer.

We surveyed Nebraska RTs' attitudes regarding their job satisfaction, their perceptions of their managers' decision-making styles (autocratic, consultative, and/or delegative), and which decision-making style they would prefer their managers to use. We sought to determine whether there is a significant correlation between RTs' perceptions of their managers' decision-making styles and the RTs' job satisfaction. The study population was 792 licensed and practicing non-managerial RTs in Nebraska, from which we randomly selected 565 RTs to survey. The self-administered, descriptive survey used 2 Likert scales (one for decision-making style and one for job satisfaction) and inquired about 57 items. The survey was mailed on October 1, 1999. On October 28, 1999, we sent a second mailing to RTs who had not responded.

We received 271 responses (response rate 47.9%). The respondents were generally satisfied with their jobs (mean ± SD Minnesota Satisfaction Questionnaire score 73.46 ± 11.63). The sub-scale scores ranged from 20 (“very dissatisfied”) to 100 (“very satisfied”). The respondents did not want autocratic managerial decision making (mean ± SD autocratic sub-scale score 4.29 ± 0.60). Autocratic decision making was associated with lower job satisfaction (r = 0.49), whereas consultative and delegative decision making were associated with higher job satisfaction (r = −0.31 and −0.48, respectively). RTs who worked in departments that had < 25 RT employees reported higher job satisfaction than did RTs in larger departments (p = 0.029).

Our survey data indicate that (1) RTs prefer delegative and consultative managerial decision making, (2) job satisfaction was highest in departments that had < 25 RTs in the department and in which the manager practiced participative decision making. These findings offer guidance for organizing optimal work environments for RTs.