Respiratory Care

The process of weaning from mechanical ventilation remains extremely difficult when only conventional methods are used after acute respiratory failure in patients with severe chronic pulmonary disease. We have enlisted extrathoracic negative pressure ventilation (ENPV), using an iron lung, to facilitate the return of spontaneous breathing in such patients.

We report weaning trials with the iron lung in 19 patients recovering from acute ventilatory failure secondary to COPD or serious thoracic deformations. All patients were intubated and initially ventilated with intermittent positive pressure ventilation. After some unsuccessful attempts at weaning with traditional methods (eg, T-piece, SIMV, PSV, CPAP), ENPV was begun using an iron lung.

17 of the 19 patients whose tubes were removed during ENPV were successfully weaned from positive pressure mechanical ventilation; two patients died. The 17 patients who were liberated from mechanical ventilation were discharged from our ICU within a few weeks and, 10 to 15 months later, are still living.

In COPD or kyphoscoliotic patients, noninvasive ENPV can be used successfully during weaning to support the patient's ventilation after the tube has been removed, until spontaneous breathing is completely restored. The favorable results that have been achieved in our ICU indicate that the use of the iron lung to facilitate weaning deserves further study.

The management staff of the Respiratory Care Department at the suggestion of the Department of Anesthesiology determined that there was a need for respiratory care practitioners (RCPs) to be trained to perform endotracheal intubation. This need was demonstrated by the frequency with which anesthesia personnel were called away from the operating room (OR) to perform endotracheal intubations in other hospital areas.

The training program included didactic instruction followed by written examination, simulations, and intubation experience in the OR under the direct supervision of a staff anesthesiologist.

Initially 15 therapists, from all shifts were trained. Currently, there are 20 fully-trained RCPs on staff. These therapists have successfully intubated 160 patients in 178 attempts over a 49 month period. All attempts followed failed attempts by other professionals. No major complications were observed in the patients intubated by RCPs.

This training program has successfully provided support for endotracheal intubation procedures, sparing the anesthesiology staff and expanding the role of RCPs in our hospital.