Breathing is their specialty. How respiratory therapists became critical during COVID
Respiratory therapists help people breathe.
And they’ve never been as valued as during the COVID-19 pandemic, when breathing was no longer a basic body function.
“It was surreal,” says Roger Plummer, 37, of Sunrise, a respiratory therapist at Broward Health North for three years. “The transition from working a regular day-to-day work assignment to when COVID hit was like night and day.
“Sometimes, there was nothing you could do except try your best as you’re literally watching the patients die before you,” he says of the pandemic’s early days.
On average, he treats 20 to 25 patients during a 12-hour shift and manages a team of respiratory therapists.
For patients who are not in dire shape, his team gives them an inhaler, the same handheld inhaler used by asthmatics. The patient inhales a bronchodilator medication, which allows the airways to open, facilitating breathing.
For patients who require more help, he puts them on a BiPAP machine, or a high-flow oxygen device that delivers two levels of air pressure to treat chronic conditions that affect breathing.
“There’s a wide range of different types of patients that we take care of, not only those who are COVID positive,” says
Plummer, a clinical instructor at Nova Southeastern University, where he’s been teaching respiratory therapy for four years.
Arens Alexis, the manager of respiratory therapy at Broward Health North, is a big fan of Plummer’s.
“He takes great care of patients and is very passionate about what he’s doing,’’ said Alexis, 38, of Coconut Creek. “He’s the team leader, as a charge therapist. He also helps us with recruiting team members for the department and helps train new staff.”
LESSONS FROM COVID
Alexis noted the learning curve they’ve had with COVID.
“Before, we used to put the patient on the ventilator. Now, we try noninvasive therapies like a high-flow nasal cannula or BiPAP (bi-level noninvasive therapy),” he said.
He said that a person’s lungs become accustomed to being on a ventilator and then have trouble working for themselves once they’re taken off.
Susheel Pradhan, 61, of Pembroke Pines, has served as a respiratory therapist at Memorial Hospital West for 12 years.
“Our main goal is to help patients’ breath better,” Pradhan, who came to the United States in 2005 from India and studied to become a respiratory therapist. In October 2018, he was promoted to the team leader of the Intensive Care Unit (ICU).
He said that one of the greatest challenges is when patients become agitated due to being in distress, which can further complicate their breathing.
“What we try to do first is to give them some emotional support,” he says.
One of the jobs a respiratory therapist does is adjust the settings on a ventilator to get it in sync with the patient’s natural breathing, as everyone has a different rhythm of breathing. However, Pradhan warns, being on a ventilator is not ideal.
ISSUES WITH VENTILATORS
“The longer patients stay on the ventilator, the respiratory muscles do not work,” he says. “We try to get them off the ventilator as soon as possible.”
In the early days of COVID, doctors turned to ventilators to keep patients alive.
“In the beginning, we did everything for the patient yet the patients were not responding,” he said. “Before COVID, we used 10 to 12 ventilators. With COVID, we used 40 to 50 ventilators every day.”
The pandemic brought much uncertainty, with the respiratory therapists and others working nearly around the clock to figure out what would work in treating the sickest.
“It was really bad. I used to come in at 4 a.m. and figure out what the doctors did for the patient during the night shift and what the plan was for the day,” Pradhan said. “And then I would go over all the lab work.”
“In the beginning, when we intubated them, many of the patients did not make it. They passed away,” he added.
That took an emotional toll on Pradhan and the other respiratory therapists.
“Susheel is someone that knows every single patient in our ICU,” said Jeff Wieder, Pradhan’s boss and manager of the respiratory department at Memorial Hospital West. “He makes a point to learn and understand every patient there. The better he understands every patient, the better he can assist the respiratory therapists with managing their patients.”
He credits Pradhan’s love of learning and reading about medical studies as the reason behind his success in the ICU.
“A respiratory therapist is a specialist,” says Wieder. “They’re focused on the lungs. They understand the ins and outs of how the lungs work, how your body oxygenates, how a person breathes and how the other organs affect the lungs.”
And in the time of COVID, those functions are even more important. It’s why the respiratory therapists point to wearing masks and getting vaccinated to keep one safe.
“COVID is definitely not over,” says Plummer of Broward Health.
“When you see someone lose the will to live or when you’re at their bedside and see them by themselves because family is not able to visit, it’s definitely real.”
His boss, Alexis, echoed that: “People think COVID is over. COVID is not over. Now, we have different strains of the virus so it’s dangerous.”
Added Wieder: “Breathing is such a passive thing. When a person can’t breathe, you realize how important that is.”