Organ procurement organization and university-based respiratory care program partnership to develop student internships.

INTRODUCTION: Health care providers working as organ recovery coordinators (ORC) in the United States have diverse backgrounds and many of the skills needed for the position are obtained during on-the-job training. Some students in health care programs express interest in the organ procurement field but have limited experience and knowledge regarding organ procurement practices. In response to this, a partnership was developed between an undergraduate respiratory care (RC) program and its local organ procurement organization (OPO) to develop and initiate an internship designed to educate students regarding organ procurement. APPROACH: The 160-h internship was developed with collaboration between the OPO administration and faculty from the university RC program, which closely followed the OPO's formalized per diem ORC orientation model. Student reflective journals were qualitatively analyzed to determine the shared experiences during the OPO internships. FINDINGS: One RC student participated in the internship in 2017 and three RC students participated in 2019. The student interns actively participated in organ donor management in the critical care and surgical settings with the scheduled ORCs. Student progression of emotional competence and leadership were demonstrated throughout the internship. DISCUSSION: The OPO internship benefited RC students by providing opportunities for professional development that may not be available during their typical clinical rotations and strengthened their critical care skills and emotional competence. CONCLUSION: Employment as an ORC is an emerging role for respiratory therapists. Offering educational opportunities such as internships in emerging roles promotes student development and autonomy while promoting the respiratory therapy profession.

Identifying Potential Ventilator Auto-Triggering Among Organ Procurement Organization Referrals.

CONTEXT: Ventilator auto-trigger is the delivery of an assisted mechanical ventilated breath over the set ventilator frequency in the absence of a spontaneous inspiratory effort and can be caused by inappropriate ventilator trigger sensitivity. Ventilator auto-trigger can be misinterpreted as a spontaneous breath and has the potential to delay or prevent brain death testing and confuse health-care professionals and/or patient families. OBJECTIVE: To determine the frequency of organ donor referrals from 1 Organ Procurement Organization (OPO) that could benefit from an algorithm designed to assist organ recovery coordinators to identify and correct ventilator auto-triggering. DESIGN: This retrospective analysis evaluated documentation of organ donor referrals from 1 OPO in central Texas during the 2013 calendar year that resulted in the withdrawal of care by the patient's family and the recovery of organs. MAIN OUTCOME MEASURES: The frequency of referrals that presented with absent brain stem reflexes except for additional respirations over the set ventilator rate was determined to assess for the need of the proposed algorithm. RESULTS: Documentation of 672 organ procurement organization referrals was evaluated. Documentation from 42 referrals that resulted in the withdrawal of care and 21 referrals that resulted in the recovery of organs were identified with absent brain stem reflexes except for spontaneous respirations on the mechanical ventilator. As a result, an algorithm designed to identify and correct ventilator auto-trigger could have been used 63 times during the 2013 calendar year.

Effects of concurrent respiratory resistance training on health-related quality of life in wheelchair rugby athletes: a pilot study.

PURPOSE: To compare the effects of 9 weeks of training with a concurrent flow resistance (CFR) device versus a concurrent pressure threshold resistance (CPTR) device on health-related quality of life (HRQoL) in wheelchair rugby (WR) athletes. METHOD: Twenty-four male WR athletes (22 with tetraplegia, 1 with a spastic cerebral palsy, and 1 with congenital upper and lower limb deformities) were matched by lesion level, completeness of injury, and rugby classification prior to being randomly assigned to 1 of 3 groups: (1) CPTR (n=8), (2) CFR (n=8), or (3) controls (CON, n=8). Pre/post testing included assessment of HRQoL as measured by the Short-Form Health Survey Version 2.0 (SF-36v2). Manufacturer protocol guidelines for the CFR and CPTR groups were followed for breathing exercises. RESULTS: Sixteen participants completed the study (CPTR=4, CFR=5, CON=7). The Mann-Whitney U rank order revealed significantly greater reductions in bodily pain (P = .038) and improvements in vitality (P = .028) for CFR versus CON. CONCLUSION: Results from this study suggest that training with a CFR device improves some aspects of HRQoL (eg, vitality and bodily pain) in WR athletes. Further research with a larger sample size is needed to examine the impact of these devices on improving HRQoL for wheelchair athletes.

Effects of respiratory resistance training with a concurrent flow device on wheelchair athletes.

BACKGROUND/OBJECTIVE: To determine the effect of respiratory resistance training (RRT) with a concurrent flow respiratory (CFR) device on respiratory function and aerobic power in wheelchair athletes. METHODS: Ten male wheelchair athletes (8 with spinal cord injuries, 1 with a neurological disorder, and 1 with postpolio syndrome), were matched by lesion level and/or track rating before random assignment to either a RRT group (n = 5) or a control group (CON, n = 5). The RRT group performed 1 set of breathing exercises using Expand-a-Lung, a CFR device, 2 to 3 times daily for 10 weeks. Pre/posttesting included measurement of maximum voluntary ventilation (MVV), maximum inspiratory pressure (MIP), and peak oxygen consumption (V(O2peak)). RESULTS: Repeated measures ANOVA revealed a significant group difference in change for MIP from pre- to posttest (P < 0.05). The RRT group improved by 33.0 cm H2O, while the CON group improved by 0.6 cm H2O. Although not significant, the MW increased for the RRT group and decreased for the CON group. There was no significant group difference between V(O2peak) for pre/posttesting. Due to small sample sizes in both groups and violations of some parametric statistical assumptions, nonparametric tests were also conducted as a crosscheck of the findings. The results of the nonparametric tests concurred with the parametric results. CONCLUSIONS: These data demonstrate that 10 weeks of RRT training with a CFR device can effectively improve MIP in wheelchair athletes. Further research and a larger sample size are warranted to further characterize the impact of Expand-a-Lung on performance and other cardiorespiratory variables in wheelchair athletes.

Teaching Health Care Students the Radial Arterial Puncture Procedure.

The radial artery puncture is a frequently ordered medical procedure for patients requiring blood gas analysis. Deviating from the proper procedure increases the likelihood of error and jeopardizes patient safety. The teaching methodology for the radial artery puncture is rarely addressed in the medical literature. First-year respiratory care students enrolled in a clinical practice course participated in an expanded curriculum on arterial puncture technique. The new five-step curriculum included: 1) a face-to-face lecture, 2) radial artery localization, 3) blunt-tipped needle simulation, 4) manikin arm puncture, and 5) a peer assessment video. Students participated in an inter-rater reliability exercise for step five. The multi-step process for teaching the arterial puncture stressed process over outcome. Students were required to master each step with a satisfactory evaluation to successfully pass the unit. Students also demonstrated high inter-rater evaluation scores of a peer video of the arterial puncture. Additional research is needed to determine if widespread application of the curriculum across other respiratory care programs and other healthcare disciplines is possible. The detailed report of our new curriculum offers other academic researchers the ability to formally study its usefulness.

Right Versus Left Prong Nasal Cannula Flow Delivery and the Effects of Nasal Cycling on Inspired F(IO2) in an Adult Anatomic Model.

BACKGROUND: Nasal cycling may present negative consequences for oxygen-dependent patients using a nasal cannula. This study investigates the effects of nasal cycling on the delivered F(IO2) via nasal cannula in an anatomic model following a baseline study comparing right and left prong nasal cannula oxygen flow delivery. METHODS: Flow from right and left nasal cannula prongs were measured simultaneously using thermal mass flow meters while delivering 0.5-6-L/min oxygen for 5 nasal cannulas from different manufacturers. An adult mannikin head with an anatomically correct upper airway was connected to a QuickLung Breather test lung. Nasal cannula-delivered F(IO2) was recorded using a polarographic oxygen analyzer with naris occlusion simulated by inserting a 5.0 endotracheal tube into the naris and inflating the endotracheal tube cuff. Data were recorded with both nares open, for right naris occluded and left naris patent, and for left naris occluded and right naris patent at 0.5-6 L/min. RESULTS: A paired t test demonstrated statistical differences between right and left nasal cannula prong oxygen flows (P < .01). Multivariate analysis of variance demonstrated no significant differences in nasal cannula prong flow between nasal cannula manufacturers. Repeated measures analysis of variance demonstrated significant differences for measured inspired F(IO2) (P < .01) when alternating nares were occluded and patent. The Bonferroni post hoc test showed significant differences for measured F(IO2) between patent nares and right naris patent-left naris occluded (P < .01) and between patent nares and left naris patent-right naris occluded (P < .01). Measured F(IO2) decreased by as much as 0.1 when one naris was occluded. CONCLUSIONS: Oxygen delivery by nasal cannula may be inefficient in the presence of the nasal cycle. Delivered nasal cannula oxygen concentrations decreased when bilateral nasal patency changed to unilateral nasal patency. Although statistically different, nasal cannula prong oxygen flow may not be clinically important across the full range of flows.

Suction catheter size: an assessment and comparison of 3 different calculation methods.

BACKGROUND: Current American Association for Respiratory Care (AARC) clinical practice guidelines recommend a suction catheter to endotracheal tube ratio (SC/ETT) based on the external diameter of the SC and the internal diameter of the ETT. An SC/ETT ratio of < 50% is consistent with the current recommendation. We theorized that a more satisfactory assessment of SC/ETT ratio could be accomplished using volume or area formulas and expansion of diameter recommendations. Some respiratory care texts recommend an SC/ETT ratio that exceeds the clinical practice guideline standard. METHODS: We calculated the internal volume and cross-sectional area of various ETT sizes, the external volume and cross-sectional area of various SC sizes, and the SC/ETT ratios. We also measured negative pressures created by suction in a lung model, during multiple suction maneuvers. RESULTS: Volume and area calculations provide an alternative method for determining the SC/ETT ratio. A volume or area ratio of 50% corresponds to a diameter ratio of 70%. Negative pressures during suctioning remain low at the new ratios, so a larger SC than current clinical practice guidelines still allows adequate air passage between the SC and ETT. CONCLUSIONS: Our results support an alternative SC/ETT ratio when pairing SCs and ETTs.

Comparing the effects of rise time and inspiratory cycling criteria on 6 different mechanical ventilators.

BACKGROUND: Inspiratory rise time and cycling criteria are important settings in pressure support ventilation. The purpose of this study was to investigate the impact of minimum and maximum rise time and inspiratory cycling criteria settings on 6 new generation ventilators. Our hypothesis was there would be a difference in the exhaled tidal volume, inspiratory time, and peak flow among 6 different ventilators, based, on change in rise time and cycling criteria. METHODS: The research utilized a breathing simulator and 4 different ventilator models. All mechanical ventilators were set to a spontaneous mode of ventilation with settings of pressure support 8 cm H2O and PEEP of 5 cm H2O. A minimum and maximum setting for rise time and cycling criteria were examined. Exhaled tidal volume, inspiratory time, and peak flow measurements were recorded for each simulation. RESULTS: Significant (P < .001) differences were found when comparing minimum and maximum rise time and minimum and maximum cycling criteria for each ventilator. CONCLUSIONS: Significant differences in exhaled tidal volume, inspiratory time, and peak flow were observed by adjusting rise time and cycling criteria. This research demonstrates that during pressure support ventilation strategy, adjustments in rise time and/or cycling criteria can produce changes in inspiratory parameters. Obviously, this finding has important implications for practitioners who utilize a similar pressure support strategy when conducting a ventilator wean. Additionally, this study outlines major differences among ventilator manufacturers when considering inspiratory rise time and cycling criteria.