Enhanced Respiratory Care

What is Mechanical Ventilation?

When patients are unable to breathe sufficiently on their own, mechanical ventilation may be required. Mechanical ventilation is the most common intervention used in patients admitted to ICUs (Intensive Care Units).

As defined by the American Thoracic Society:

Mechanical ventilation is a form of life support. A mechanical ventilator is a machine that takes over the work of breathing when a person is not able to breathe enough on their own. The mechanical ventilator is also called a ventilator, respirator, or breathing machine.

Non-Invasive Mechanical Ventilation involves the delivery of oxygen and the removal of carbon dioxide through a mask. It does not require endotracheal intubation and is commonly used for patients with mild to moderate difficulty breathing to ensure that their breathing difficulty does not worsen.
Invasive Mechanical Ventilation involves the placement of an endotracheal tube or tracheostomy tube. Oxygen is delivered through the patient’s mouth or nose into the trachea.

What is Prolonged Mechanical Ventilation?

When patients are administered mechanical ventilation for more than 21 days for at least 6 hours per day, this is called Prolonged Mechanical Ventilation (as defined by the Centers for Disease Control and Prevention – CDC).

Prolonged Mechanical Ventilation is a patient safety issue. Researchers have found that the care of patients who have prolonged mechanical ventilation is expensive and their overall outcomes are often poor. As Mario Fadila, MD, and his colleagues at the SIU School of Medicine and University of Missouri write:

“Prolonged mechanical ventilation increases the risk of pneumonia, barotrauma, tracheal injuries and musculoskeletal deconditioning. At the same time, delayed weaning is associated with increased morbidity, mortality, hospital stay and risk of long-term care facility discharge.”

Each year, approximately 20 million patients require admission to the ICU and mechanical ventilation.

The need for mechanical ventilation may occur with breathing and respiratory illnesses, such as asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, pneumonia, and lung cancer. During the COVID pandemic, there was a surge in patients requiring mechanical ventilation. In the US, one study found that almost 90% of COVID patients required mechanical ventilation. An audit of patients from England, Wales, and Northern Ireland found that two-thirds of COVID patients who required critical care in the UK had mechanical ventilation within 24 hours of admission. Most COVID patients who experienced respiratory failure often required prolonged mechanical ventilation for two weeks or longer.

What is Respiratory Compromise?

Such patients are suffering from Respiratory Compromise.

As defined by the Respiratory Compromise Institute, to which PPAHS is a founding member:

Respiratory Compromise (RC) is a state in which there is a high likelihood of decompensation into respiratory insufficiency, respiratory failure or death, but in which specific interventions (enhanced monitoring and/or therapies) might prevent or mitigate decompensation.

Long-term ventilation is utilized in a variety of settings including long-term acute care facilities and skilled nursing facilities.

What is Ventilator Weaning?

Once patients are mechanically ventilated, it can be difficult to get these patients off of mechanical ventilation. This process of getting patients off of mechanical ventilation is called Ventilator Weaning.

Ventilator Weaning is a process that can take days or even months to get patients off of mechanical ventilation. However long the process, the goal is to have these patients breathe on their own.

The Enhanced Respiratory Care program is based on standards published by the American Association for Respiratory Care (AARC), which achieved liberation rates of 65% (i.e. getting a patient off of mechanical ventilation) and earned national recognition of excellence from the American College of Chest Physicians (CHEST). Implemented in 2002 in Tennessee as part of TennCare’s plan to improve enhanced respiratory care quality, this program saw resource utilization rates double from an average of $350 to $700 per day.

Our Enhanced Respiratory Care program consists of two facets:

Certification of Clinicians in Enhanced Respiratory Care
Accreditation of Healthcare Facilities in Enhanced Respiratory Care

To view and download a PDF copy of the brochure about the PPAHS Enhanced Respiratory Care program, please click here.

Who Provides Respiratory Care?

Patients requiring Enhanced Respiratory Care need the attention of a clinician specifically and adequately trained to provide Respiratory Care. There are primarily two types of specialty clinicians who provide Respiratory Care:

A Pulmonologist is a physician who treats patients with respiratory illnesses, like chest infections, pneumonia, and emphysema. This type of physician specializes in lung conditions.
A Respiratory Therapist is a clinician who specializes in treating patients who have breathing disorders. Respiratory Therapists treat a range of patients, from premature infants whose lungs are not fully developed to elderly people with lung disease. They give patients oxygen, manage ventilators, and administer drugs to the lungs.

According to the AARC (American Association for Respiratory Care) position statement defining respiratory care, providing Respiratory Care requires a complex set of knowledge and skills:

Respiratory Care is the health care discipline that specializes in the promotion of optimum cardiopulmonary function and health and wellness … employ[s] scientific principles to identify, treat and prevent acute or chronic dysfunction of the cardiopulmonary system. Knowledge and understanding of the scientific principles underlying cardiopulmonary physiology and pathophysiology, as well as biomedical engineering and application of technology …