Respiratory Therapy by Farzad

Let’s read an article a month– June 2020

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Every month I try to read an open-access article. After reading the article, I share the title 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 article on June 20th, 2020. I spent a few days with it, and now I share it with you.

Predictors of progression in systemic sclerosis patients with interstitial lung disease

  Oliver Distler, Shervin Assassi, Vincent Cottin, Maurizio Cutolo, Sonye

  K. Danoff, Christopher P. Denton, Jörg H.W. Distler, Anna-Maria

  Hoffmann-Vold, Sindhu R. Johnson, Ulf Müller Ladner, Vanessa Smith,

  Elizabeth R. Volkmann and Toby M. Maher

  Eur Respir J 2020 55:1902026; published ahead of print 2020,

  doi:10.1183/13993003.02026-2019 OPEN ACCESS

https://erj.ersjournals.com/content/erj/55/5/1902026.full.pdf

Top 3 reasons why I enjoyed reading this article:

-A well-written review of key pathways implicated in systemic sclerosis-associated interstitial lung disease (pp2-4 ). Inflammatory pathways are complex and while I enjoy reviewing them, I never tend to be able to memorize them. There is also a nice diagram that goes along with the description (i.e. Figure 1 on page 3).  

-An insider and expert view of the challenges involved with the disease diagnosis. When it comes to interstitial lung disease, there is so much for me to read and learn about. I am involved with the Pulmonary Diagnostic side of respiratory care, and mostly I see patients with confirmed diagnosis of interstitial lung disease (usually in the later stages). Occasionally I do see patients who have some indications in an imaging test, CXR or Chest-CT, and are visiting the PFT lab for additional information. “One potential barrier to diagnosis a lack of awareness within primary care of SSc, which can lead to late referrals” (p.5). 

-If you are involved with pulmonary diagnostics, you will enjoy this article as there are references to lung function values (with some references to 6MWTs) (found on pp 7-8).

Happy Learning!

Farzad Refahi
June 25, 2020

http://respiratory.blog/let’s-read-an-article-a-month–june-2020/

Unsure? Get Tested!

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A nasopharyngeal swab this past Friday followed the end of my deployment in acute care. A phone call from Markham-Stouffville Hospital confirmed a negative COVID-19 result. I endured 15 seconds of discomfort for a comfortable return to the PFT lab. It was a happy ending to being upfront.

Almost 4 months ago we stopped our pulmonary function testing. I was deployed to the acute care side of the respiratory therapy department. Helping in ICU, Emerg and wards. It was a quick refresher and a dive back to a side of respiratory care that I had not been involved with for almost 6 years.

While my exposure to COVID-19 patients and equipment were with proper PPE utilization, one could never be too sure. At the end of my rotations, and before seeing vulnerable patients in the PFT lab, I decided to get tested.
This is not the first time I have been tested over the last 3 months. With the start of spring, my seasonal allergies became evident. Mornings with red eyes and a runny nose were becoming the new norm for me. At the start of all this, and with these new symptoms, screeners and the occupational health department sent me for testing.

While I was relaxed, comfortable and calm about my recent, second test, the feeling about my first test was not the same. With my first test, I felt almost embarrassed and annoyed. Calling my manager and wondering what my colleagues would think about me being off due to COVID-19 was at the back of my mind. I didn’t want to be known as the person who didn’t use his PPE correctly or be known as the person who got deployed to be helping but now has become a vector. The only reason I am sharing my past false perception and beliefs is to share two points with you. Firstly, of course, you should do your best to follow proper hand hygiene, PPE, social distancing and other recommendations. Even if you have done all of the above correctly, it doesn’t mean that you are 100% protected. Secondly, there is no shame in getting COVID-19. Testing is becoming more readily available, so if you have any concerns that you might have contracted COVID-19, please get tested. It is important not only to look after yourself but also to protect others.

While I work in the healthcare field in Canada, this recommendation extends to all the frontline workers in the world. Thank you for your dedication and service. To those who have followed the recommendations and remained at home, thank you for your team effort. To those who have lost their jobs, became ill with this disease, or lost someone because of it, my heart goes out to you. 2019 and 2020 have been difficult but has shown me that we do great things when we come together. #StrongerTogether.

Farzad Refahi
June 13, 2020
www.respiratory.blog/unsure?-get-tested!/

Right After Getting The Swab

Let’s read an article a month – May 30, 2020

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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.

Happy Learning!

Farzad Refahi
http://respiratory.blog/lets-read-an-article-a-month-may-30-2020/


Let’s read an article a month – April 30, 2020

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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?

Farzad Refahi
http://respiratory.blog/lets-read-an-article-a-month-april-30-2020/
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We Are In This Together

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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.”

Blog post by Farzad Refahi. Photo by TK Hammonds on Unsplash

Be safe,

Farzad Refahi
April 11, 2020
https://www.respiratory.blog/inthistogether/