In the outpatient setting, respiratory therapists provide lung function testing, oxygen testing, and education for patients.

If media coverage of the coronavirus pandemic was a word cloud, “ventilators” would occupy a prominent spot.


And critical questions abound: Will there be enough to satisfy increased demand in the hardest hit hospitals?


Will health-care providers be forced to make life-or-death triage decisions about which patients get put on them?


Those, of course, are worst-case scenarios that, with any luck, hospitals will be able to avoid.


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But what rarely gets discussed about ventilators is that these complex life-support machines don’t run themselves.


No, that vital role falls to respiratory therapists — who are specially trained in supporting all manner of treatment for breathing conditions.


As the respiratory therapy director of a Brooklyn, N.Y., hospital told CNN last week, “If you don't set it up right, that patient outcome is different. You need skilled people who have lots of experience doing this to have good outcomes with these patients.”


To better understand the role of respiratory therapists — and how what they do is being impacted by the coronavirus — we asked Dr. Samuel Gurevich, medical director for respiratory therapy at Cleveland Clinic Florida, for a quick primer:


What a respiratory therapist does


According to Gurevich, in hospitals, respiratory therapists work hand in hand with the physicians and nurses to monitor a patient’s respiratory status, give breathing treatments, obtain blood gas measurements, assist with invasive procedures such as bronchoscopies and intubations (for which patients must be sedated), and provide adjustment and management of the ventilator.


“They have advanced training and licensing in the most advanced modes of oxygen therapies,” he said.


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Other non-invasive oxygen therapies include conventional oxygen masks as well as the more elaborate “high-flow systems and BiPAP machines” noted Gurevich.


In the outpatient setting, respiratory therapists provide lung function testing, oxygen testing, and education for patients. They also run pulmonary rehabilitation programs for patients with chronic lung disease, run smoking cessation programs, and assist in treating obstructive sleep apnea with CPAP adjustments.


“Say a patient has an event like a heart attack that affects his or her pulmonary system. After the event, the patient needs pulmonary rehabilitation — and that’s done by the respiratory therapist.”


For the most gravely afflicted patients, who can’t sustain lung function on their own, being put on a ventilator buys them time.


But the goal, of course, is to get the patient off the ventilator as quickly as possible — according to Time, “generally speaking, 40% to 50% of patients with severe respiratory distress die while on ventilators” — and that’s why the respiratory therapists’s role is critical.


“When a patient requires a ventilator, the respiratory therapist is the expert in setting up and working the ventilator,” said Gurevich. “They work with the physician to make adjustments and change settings. They are instrumental in helping the patient get the most benefit out of the ventilator.”


Meeting the increased demand


The American Association of Respiratory Care says there are approximately 155,000 licensed respiratory therapists in the U.S. In a typical South Florida intensive care unit, a respiratory therapist usually cares for and monitors eight or so patients simultaneously during a given shift. But in the pandemic’s worse-case “spike” scenarios — in which there were dozens of patients on ventilators at once — do we have enough respiratory therapists to meet demand?


Gurevich is optimistic.


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“Like all medical professionals, respiratory therapists are under strain to remain healthy and continue to be able to support the much larger needs during this pandemic,” he said. “Just like first responders, nurses and physicians, if we cannot keep our respiratory therapists healthy and able to work, it will not matter how many ventilators we have.”


Now that the general public is becoming more aware of how critical ventilators are in keeping the most severely ill coronavirus patients alive and with a chance of recovering, Gurevich is only too eager to sing the praises of the often-overlooked respiratory therapist.


“Respiratory therapists are often the unsung heroes of this pandemic. They are on the front lines, in emergency rooms and ICUs, taking care of COVID-19 patients, saving lives and putting themselves at risk every day.”


This story originally published to palmbeachpost.com, and was shared to other Florida newspapers in the USA TODAY Network - Florida.