MANAGING VENTILATED PATIENTS: THE SHARED RESPONSIBILITIES OF NURSES AND RESPIRATORY THERAPISTS

Abstract

Respiratory therapists (RTs) frequently collaborate with nurses on mechanical ventilation in intensive care units (ICUs); however, the extent of this collaboration is not well understood. The purpose of this educational paper is to describe the shared responsibilities of ventilated patients by ICU nurses and RTs. The article further explores how nurses and RTs each contribute to collaborative care of the ventilated patient. A narrative review of the literature prompted further exploration into the congruence of ventilated patient responsibilities. Studies investigating collaboration between nurses and RTs on ventilated patients were reviewed. Key contributions of both professions to ventilator management and concurrent care of the ventilated patient were summarized. This education paper provides a framework for better understanding the collaborative care of ventilated patients.

Mechanical ventilation is both a highly complex and high risk therapeutic modality. It is one of the most common interventions provided by intensive care units (ICUs). Nevertheless, the development and advancement of this technology has far outpaced personnel’s ability to use it safely. Effective mechanical ventilation requires a good understanding of the mechanics of breathing and control of ventilation, as well as knowledge of the various modes of ventilation, their rationale, and their settings. Continuous adjustment is also necessary as the patient’s situation changes, which is common in a heterogeneous population with acute respiratory failure. Adverse effects of poor ventilation management include inadequate oxygenation and ventilation, adverse effects of oxygen and positive pressure ventilation, barotrauma, and patient-ventilator asynchrony. In the EU, healthcare systems have evolved to focus on multi-professional teams. Goals for improvement include cooperation and communication among the members of the healthcare team as well as outcomes that are important to healthcare workers, such as job satisfaction, reduction of job strain, workflow satisfaction, and efficiency. Collaborative care and shared responsibilities for ventilated patients among nurses and respiratory therapists (RTs) continue to be less well explored. In 2012, the Collaborative Care of Patient with Invasive Ventilation among Nursing Specialties (CCV) task force was founded in Japan to promote safety, satisfaction, and efficiency in the management of ventilated patients. In 2016, this task force had expanded to include ICU medicine, pulmonary medicine, rehabilitation, and other areas of expertise. Incorporating this expanded expertise allows consideration of an even wider and deeper range of subjects (Jacinta Ladipo, 2017).