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Wednesday, July 17, 2013

RT to titrate BiPAP

I love "RT to titrate BiPAP" orders. I wish there were "RT to titrate Vent" orders too.  I had two patients today come up from ER, both patients I set up on BiPAP.  One was put on for exacerbation of COPD and the other CHF.  Both needed it then.  But, by the time the patient was admitted, the BiPAP was no longer needed.  So I simply discontinued the therapy for both patients. 

Yes, they were sooooo happy.  I got smiles from both of them when I said, "I will keep this on standby, but I think you don't need it right now -- unless you want it.  If you want it I will be happy to put it on you."

"Oh, no no no no no." Smiles from the patient. 

Perhaps if we had more RT to Titrate vent orders there'd be a significant drop in ventilator hours.  What do you think?


Anonymous said...

Yes, absolutely there would be a drop in vent hours which would lead to less time for the patient spent in the icu which would lead to money saved by the hospital. However, this requires RT's willing, ready, and knowledgable to take this on with physician's support. No knob turning allowed. Apathy on the RT's end and distrust from the docs can be barriers to these types of protocols.

Rick Frea said...

True, but doctors get apathetic too. Dr's also get burned out from overwork, just like RTs. Even an apathetic RT should be able to manage a ventilator, once trained to do so.

On a side note here, I think our physicians are leaning towards giving RTs control of the ventilators. In fact, it's sort of already happened. I'll have to write a post regarding this in the coming days.

Anonymous said...

Im an RT student and recently went to ICU rotation we were told that RT's were the only ones that could make vent changes!
I was pleased to hear that

Rick Frea said...

It should be no other way. In many cases, you cannot just turn one dial without adjusting another, and most physicians don't understand this.