A Pre-Pandemic Evaluation of the State of Staffing and Future of the Respiratory Care Profession: Perceptions of Louisiana Respiratory Therapists.

BACKGROUND: Workforce development for the respiratory therapy (RT) profession is a growing concern. Upcoming staffing difficulties are expected due to retirement, attrition from the profession, and decreased enrollment in accredited RT programs nationwide. This study assessed respiratory therapists' perceptions of staffing needs and future trajectory of the RT profession. METHODS: This cross-sectional study utilized a modified 39-question survey tool delivered via e-mail to 618 Louisiana members of the American Association for Respiratory Care (AARC) between November 2019-February 2020. RESULTS: The response rate was 19% (118/618). Although 50% of respondents perceived understaffing, 77.6% indicated the importance to remain in the RT profession. A majority (93.1%) agreed on the importance of maintaining an active membership in the AARC. Respondents working in a hospital setting perceived understaffed work environments more often than other groups. Salary was most important to the employee (33.6%, 39/116), followed equally by room for growth (14.7%, 17/116) and scope of practice (14.7%, 17/116). For the future of the profession, the ability to assess patients and develop care plans and the ability to receive reimbursement for services were indicated as most important factors. Most (69.8%) agreed that the entry-level minimum should be increased to the bachelor's degree, and 21.6% agreed the master's degree in RT should be supported to increase scope of practice. CONCLUSIONS: This study indicated a consistent perception of understaffed work environments in respiratory care, and respondents expressed a perceived importance of remaining in the RT profession. This study also indicated support for raising the entry-level standard in RT and a desire for higher education to achieve professional growth and advancement.

A comparison of metered-dose inhaled albuterol versus endotracheal liquid bolus albuterol for the treatment of bronchoconstriction.

INTRODUCTION: Aerosolized albuterol delivery is a mainstay treatment for bronchoconstriction; however, almost no data exist that evaluate the clinical outcome of instillation of an endotracheal liquid bolus (ELB) of a bronchodilator directly into the airway. METHODS: This randomized trial sought to evaluate the efficacy of albuterol lavage via artificial airway with accompanied patient positioning. Subjects receiving mechanical ventilation for acute respiratory failure with clinical manifestations of bronchoconstriction were assigned to initially receive either traditional albuterol via metered-dose inhaler (MDI) or albuterol via ELB lavage with follow-up administration of the other therapy after a 4-h washout period. Clinical data were collected at baseline and at 5 and 30 min post-treatment. RESULTS: Fourteen subjects (5 males, 9 females; mean age of 57.5 y) were included in this study. In the group receiving initial ELB, peak airway pressure decreased significantly (P = .02), and a significant decrease in airway resistance mean scores was seen from baseline to 30 min post-treatment (P < .001) and from 5 to 30 min post-treatment (P = .003), with no significant effects seen with follow-up MDI. In the initial MDI treatment group, no significant effect on peak airway pressure or airway resistance was noted. S(pO2) increased at 5 min post-treatment with ELB. In contrast, S(pO2) decreased 30 min post-treatment with MDI. Mean arterial pressure decreased post-treatment with ELB. The pattern in heart rate change post-treatment with ELB was similar to that post-treatment with MDI, with a significant increase at the 5-min interval from baseline (P < .01), followed by a significant decrease at the 30-min interval (P < .001). There were no differences in dynamic compliance at each time interval following administration of both the MDI (P = .92) and ELB conditions (P = .18). CONCLUSIONS: ELB albuterol lavage may be a viable option to reverse bronchoconstriction in intubated patients with limited response to traditional aerosolized albuterol via MDI.