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Thursday, November 1, 2007

I'm smart enough to manage BiPap

I don't know about you guys, but when it comes to my BiPap machine I get to do whatever I want. I don't understand why doctors at my hospital give me that power, but they do. It's amazing.

When it comes to running a vent, I'm pretty much a button pusher here at Shoreline Hospital. Sure, doctors will listen to my advice (on occasion), but he or she gets the last word.

When it comes to BiPap, I am the decision maker. I asked Dr. Piddle once what he recommended, and he told me to "do whatever you need to do to get that sat (Spo2) up."

Cool. I increased PEEP to 18. Heck, I did my own PEEP study. This is great. It's that way with every BiPap and CPAP patient. I even get to decide whether to use PEEP or CPAP. It's awesome.

In fact, almost all of our doctors simply order, "BiPAP to patient tolerance." This means essentially that I get to do whatever I want. I even get to adjust per EtCO2, SpO2 and ABGs.

Funny thing is, I don't see BiPAP as any different than running a vent. It's invasive ventilation, only the patient is wearing a mask instead of having a tube thrust into this or her throat. IPAP is the same as PS, EPAP is the same as PEEP, and FiO2 is the same as FiO2.

My point is: if the doctors at my hospital let us run BiPAP at our own free will, why can't we manage the vent? I bet we could. I bet we'd do a heck of a good job at it.


Unknown said...


I'm with you 100%, I did work at a hospital before where we managed the Vents and it worked great. Maybe someday this will come online for us, keep pushing for it.

Glenna said...

I totally agree. BiPap is invasive ventilation. I'm lucky enough to work at a hospital where our pulmonologists not only trust us, they welcome our help. One of pulmos was overheard saying to a new pulmo "these guys will make your life a whole lot easier if you'll let them do what they were trained to do." Man, you can't beat that, you know? Which just inspires us to perform even better under our very RT-oriented vent (including BiPap) protocols. I find the work so much more challenging and love going to work knowing that I'm really in charge of my patient's respiratory health. Most of our docs write vent orders as a variation of this: "vent per RT protocol". Our protocols include both vent management and weaning. We call the doc for extubation orders when we can tell them the pt is ready. It makes me really proud to go to work.

Unknown said...

Our docs don't even write vent orders. If the patient is intubated, we place them on the ventilator and then run it according to our protocol. Our protocols are built on a sliding-scale sort of system, so the patient begins on the Standard Vent Management Protocol and can then slide either up into ARDS, APRV or Oscillator protocols or down into the weaning protocol depending on their numbers.

This is a huge change for me: I used to work at a physician-driven hospital, where RTs simply pushed buttons for doctors. And I can tell you that we have much better results here where the RTs run the vents by standard protocols than we did when we had competing doctors writing random orders.

And awesome. You're absolutely right: it's both invasive AND a ventilator, and if you can run that you can certainly run a vent.

Rick Frea said...

I would really love to work at a hospital like yours. I need the challenge.

Rick Frea said...

I'm a sinner: I'm envious.

Anonymous said...

Well to be honest with you, IPAP is not the same as pressure support. Pressure support is actually the difference between IPAP and EPAP.

Rick Frea said...

You are correct, excuse my error.

Anonymous said...

Pressure support is for spontaneou s breathing. Patient demand a breath and the vent detect and pressure support deliver the maximum pressure - example is 30 cmH2o. 30 is the maximum will be delivered when a patient demands.

Anyone can fonfirm?