Every month I try to read an open-access article. After reading the article, I share the tittle and associated link with my followers. This is to encourage clinicians to read articles, stay up to date, and continue to grow.
This month I found a great editorial post on May 15th, 2020. I spent a few days with it, and now I share it with you.
Will children reveal their secret? The coronavirus dilemma Luca Cristiani, Enrica Mancino, Luigi Matera, Raffaella Nenna, Alessandra Pierangeli, Carolina Scagnolari, Fabio Midulla European Respiratory Journal 2020 55: 2000749; DOI: 10.1183/13993003.00749-2020 https://erj.ersjournals.com/content/55/4/2000749
You will be presented by suggestions, ideas and theories such as high angiotensin-converting enzyme 2 (ACE2) receptor concentration, innate immune response as both protective and a destructive mechanism, and constitutional elevated lymphocytes.
Every month I try to read an open-access article. After reading the article, I share the tittle and associated link with my followers. This is to encourage clinicians to read articles, stay up to date, and continue to grow.
I found an article on April 25th, 2020. I spent a few days with it, and now I share it with you.
Endotracheal cuff pressures in the PICU: Incidence of underinflation and overinflation
Richard W. Wettstein MMEd, RRT, FAARC, Donna D. Gardner DrPH, RRT, FAARC, Sadie Wiatrek MSRC, RRT, Kristina E. Ramirez MPH, RRT, CHES, Ruben D. Restrepo MD, RRT, FAARC Published online January 21, 2020 https://bit.ly/2VRHC0E
Top 3 reasons why I enjoyed reading this article
I enjoyed reading this submission to Canadian Journal of Respiratory Therapy (CJRT) as it was a quick read, and served as a nice review of reasons for using cuffed versus uncuffed ETT in paediatric population. Also, it reviewed possible benefits and drawbacks of using cuffed ETT in paeds. MOV, MLT versus pressure manometer techniques were discussed.
What you can expect from this study
In this study rate of under- or over-inflation was assessed. Also, if CP was outside of norm, possible association with gender, age, ETT size and number of days intubated prior to CP measurement was evaluated (second goal of the study. P2).
Considerations
The main limitation to this study was its small size (n=20).
Thoughts?
Happy reading. Let me know about your personal opinion on using cuffed versus uncuffed ETT in paediatric patients. Also, what’s your preferred way to monitor cuff pressures?
Post by Farzad Refahi. Photo by Tobias Mrzyk on Unsplash
Just like many of you, I have and will continue to go through changes during these challenging times.
My Journey So Far
Since our outpatient testing lab has closed, I have been deployed to assist the acute care respiratory therapy (RT) team. I have been working in Pulmonary Function Test (PFT) labs exclusively for the past 5 years. This has made me re-assess my awareness of acute care practices. I pulled out old notes and textbooks, and have been studying daily to refresh my knowledge. I had to reintroduce myself and get comfortable with specific ventilators and equipment (and get trained on some new ones). Being back in acute care, even in a supporting role, has made me feel vulnerable. I want to help the team in patient-care without being a burden to the team, without expressing false confidence, and without making mistakes that can impact patient care (and my licence to practice).
Continuous Support and Learning
Going forward, I will continue to help the acute care RTs in my hospital with steps that can make their lives easier which includes keeping an eye on the inventory, making ‘grab and go’ packages, circuiting vents, being the runner, and looking after simple respiratory assessments. On my own time, I will continue to review my RT knowledge using available resources such as my textbooks, notes, online videos and courses, networks and colleagues. I’ll be honest with myself and colleagues about my weaknesses and strengths, asking questions when needed, while trying to be mindful and aware of stress levels.
My Supportive Network
This transition has not been simple, but I am lucky to have a lot of support. The RT team at Markham-Stouffville Hospital has been very supportive. My fellow deployed RTs are amazing in team-work and supporting each other. Thanks to all the acute care RTs, and other healthcare providers, for all your hard work. I want to give a shoutout to the team at RTSO who have been understanding and supportive of my deployment. Also, to RT’s like Thomas Piraino, who are contributing to knowledge sharing and best practices for Mechanical Ventilation in this crisis. Tom, I don’t know how you manage all this! Research, clinical work, publications, family and still have time to do daily Mechanical Ventilation Q & A sessions (6 pm on his Facebook page https://www.facebook.com/respresource/ ). Your contribution to the RT profession is much appreciated!
Also, a big shoutout to my amazing wife, who supports me through all these challenging times. I am lucky to have strong family support in my life!
Take Care of Yourself
Be honest with yourself about your strengths and weaknesses. Navigating a new environment, at work and in life, can be scary and it tests us. Even though we may be trained, competent and capable, we all have doubts once in a while. I know its hard to take a moment for yourself in a time of crisis, but we also need to be mindful of our own physical and mental health so we can help our patients as well.
Final Thoughts
These are unique and challenging times. We are in this together! I am going to finish this post with a quote from Brené Brown (Daring Greatly. 2012).
“Sometimes the bravest and most important thing you can do is just show up.”
During stressful times we tend to focus on the challenges and the struggles. It is important to not lose sight of the positive in our lives and to give gratitude.
Over the past few weeks, I have witnessed many amazing people stepping up to help everyone. Thank you, Sue Jones and Kelly Hassall, for your ongoing dedication and leadership to help RTs through Respiratory Therapy Society of Ontario (RTSO). Thank you, Gino Luigi De Pinto and Sue A., for keeping the RTSO website up to date with the latest resources.
Thank you, Thomas Piraino, for putting together the great resource on your website, and answering questions live on social media.
Also, a big thank you to Carolyn McCoy, Andrew West, Carole Hamp and Kevin Taylor for your ongoing hard work in the background.
Thank you to RT programs for lending your ventilator to hospitals, and taking your third-year students out of clinical rotations to keep them safe.
Farzad Refahi March 23, 2020 www.Respiratory.Blog/gratitude/ [End]
Today is March 20th, 2020. The first day of spring. Happy Nowruz to all those who celebrate the new year. Iranians, among few other nations, have the first day of spring as their new year.
While new year celebrations involve visiting others and sharing delicious food, this year will be quiet. I hope it is quiet. Let’s continue the social isolation. Let’s continue to practice proper hand hygiene. Let’s self-isolate if you are feeling unwell. Let’s think about the vulnerable population and the elder members of the family.
My blog posts are usually meant for clinicians. This time, I am writing to every one, since dealing with COVID-19 is beyond the work of clinicians and healthcare system.
While you monitor your physical health, please don’t forget about your mental health. There are various electronic and video communication options that allow you to connect with others. Call the elderly to check-up on them. If you know someone in isolation, ask if they require groceries (being dropped behind their door).
Those who experienced SARS in 2003 may experience higher levels of anxiety around this time (especially clinicians). Make sure you connect with proper resources, support and intervention if required.
Give yourself mental breaks. Find a few trusted sources for news and COVID-19, and only review those. Constantly reading about it may induce increased anxiety. ( www.RTSO.ca is one of my trusted sources.)
Find appropriate stretches and exercises that can be safely done at home. Stay hydrated. Use this opportunity to stop smoking. Pick up that book that you always intended to read!
Don’t forget about the positive. Give gratitude for the good in your life. There are many great people who are doing their best to help out. A quick shout out to respiratory therapists and clinicians who continue to work to keep us healthy. Fatima Foster is creating a supportive online community for clinicians who are experiencing some anxiety around this time. John Meloche from Melotel Inc. is using the resources in his company to support communities and organizations who have non-for-profit COVID-19 support groups. There are many more examples if you look for them!
