ABSTRACT
Respiratory therapist is a new profession in medicine, who works therapeutically with people suffering from pulmonary disease.Their timely treatments of patients with cardiopulmonary insufficiency can significantly reduce mortality in pediatric intensive care units.This review focused on the responsibilities of respiratory therapists, the importance of respiratory support therapy in children, and the most updated development in China as well as the problems to be solved.
ABSTRACT
Objective:To investigate the clinical practice of Chinese respiratory therapists (RTs) participating in the treatment of coronavirus disease 2019 (COVID-19) patients and summarize the experience and role of RTs in the treatment of pandemic infectious diseases.Methods:A self-designed questionnaire was used to investigate the RTs who treated COVID-19 patients in 31 provinces, cities and autonomous regions in China. The survey questionnaire included the basic work of RTs, the specific work of the treatment for COVID-19 patients and problems encountered at work.Results:A total of 126 questionnaires were issued and 40 valid questionnaires were collected from RTs who treated COVID-19 patients at 22 COVID-19 designated hospitals in 8 provinces and municipalities. This included 7 hospitals in Wuhan, the epicenter of the epidemic. In their medical team, RTs accounted for 2.9% (1.5%, 6.7%) of medical staff, the working experience of the RTs was about (6.2±5.4) years, the ratio of RTs to beds was about 1∶11 (1∶5, 1∶26), and 85.0% (34/40) of RTs were transferred from other hospitals. 97.5% (39/40) of RTs were involved in formulating individual respiratory care strategies in their medical teams, and they were all involved in the evaluation of respiratory care and decision-making as well as the early identification of deterioration of respiratory function. All RTs [100% (40/40)] indicated that they would actively monitor patients' respiratory status, increase the means and frequency of the monitoring, implement standardized oxygen therapy, prevent ventilator-associated lung injury (VALI), and standardize the management of artificial airway. However, less than 50% of RTs had carried out stress and strain, transpulmonary pressure, partial pressure of end-tidal carbon dioxide (PetCO 2), end-expiratory lung volume, electrical impedance tomography (EIT) and other respiratory function monitoring. 85% of RTs conducted training and education related to respiratory care and formulated relevant standard operating procedures for their medical teams. More than 90% of RTs led the implementation of high-flow nasal cannula oxygen therapy (HFNC), pulmonary protective mechanical ventilation, prone ventilation, pulmonary rehabilitation, airway management, transfer of critical patients, and other respiratory treatment. Conclusions:RTs performed their professional role fully in the assessment, decision-making, and clinical practice in the treatment of COVID-19 patients. However, the manpower shortage of RTs is extremely prominent, the practical experience has provided the basis for the future treatment of infectious respiratory diseases and effectively promoted the development of respiratory care in China.
ABSTRACT
La evidencia existente sobre kinesiología respiratorias es limitada en la actualidad. Los objetivos de este trabajo son describir el uso de las técnicas kinésicas respiratorias, dispositivos de uso terapéutico, equipamiento de monitoreo y referir sobre la actividad científica de los kinesiólogos respiratorios de la Argentina en el año 2008. Realizamos una encuesta con 78 preguntas que fue enviada vía internet a 100 kinesiólogos respiratorios. Contestaron 70 de 13 provincias. Las técnicas más utilizadas fueron espiraciones forzadas (97%), vibraciones manuales (89%), cambio de posición y asistencia de la tos (96%), y los dispositivos más utilizados fueron aspiración de secreciones (94%), e hiperinsuflación manual (86%). Al tomar en consideración la edad, los kinesiólogos mayores de 40 años utilizaron más la percusión manual torácica (57.1% vs 37.5%), el Flutter® (42.9% vs 21.4%), el Insuflador - exuflador (42.9% vs 19.6%); p=NS y las vibraciones mecánicas torácicas (35.7% vs 10.7%); p=0,02. Los principales estudios de monitoreo fueron: saturación de oxigeno (96%), medición del pico flujo espiratorio (79%), fracción inspirada de oxigeno (73%), medición de presiones inspiratorias y espiratorias (73%). El 69% publicó trabajos científicos mientras que el 91% refirieron interés en participar en uno. Se concluye que la encuesta refleja que la kinesiología respiratoria en Argentina hace uso de las técnicas kinésicas, dispositivos y equipamiento de monitoreo con criterios actualizados, como también muestra un alto interés en la participación científica.
The existing evidence of respiratory therapy is limited at the present time. The objectives of the survey were to describe the use of respiratory therapy techniques, devices of therapeutic use, appliance of monitoring and scientific activity of the respiratory therapists of Argentina in 2008. A questionnaire containing 78 questions was sent via Internet to 100 respiratory therapists. Answers were received from 70 therapists of 13 provinces. The most often used techniques were forced expiration (97%), manual vibration (89%) and change of position and assistance for coughing (96%). The devices most often used were those for aspiration of secretions (94%), and manual hyperinflation (86%). Taking into account the age, therapists over 40 years old used more often manual chest percussion (57.1 % vs 37.5%), the Flutter® (42.9% vs 21.4%), the insufflator - exsufflator (42.9% vs 19.6%), p = NS and mechanical thoracic vibrations (35.7% vs 10.7%), p= 0.02. The main monitoring tests were: oxygen saturation (96%), measurement of peak expiratory flow (79%), inspired fraction of oxygen (73%), and inspiratory and expiratory pressure (73%). While 69% of therapists published scientific papers, 91% expressed interest in participating in scientific activities. The results of the survey reflect that the respiratory therapists in Argentina are updated in the use of respiratory techniques and monitoring devices and appliance. They also show a high scientific interest in participating in scientific activities.