The role of respiratory therapists in the treatment of coronavirus disease 2019 patients in China / 中华危重病急救医学

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.