“A number of my RT colleagues at the Health Sciences Centre (HSC) in St. John’s, Newfoundland utilize remote monitoring for surgical. In many instances there is only one RT covering all the surgical floors as well as the medical floors, and remote monitoring has proven to be a useful process for respiratory care as it allows the nurses to also act quickly as first responders when a respiratory compromise incident occurs. Remote monitoring has also decreased the demands for one on one care with by either the RT or RN and there is no need for additional staff to manage special care beds. Overall it has led to better use of health human resources and a reduction in cancelled surgery because of lack of resources.”
Jessie Cox, RRT, FCSRT, CCAA
St John’s Newfoundland
"As an active ACLS instructor and Respiratory Therapist, I constantly highlight the significance of capnography in the management of cardiac arrests’. Capnography’s inclusion has completely changed the way we view and manage cardiac arrest scenarios."
Marco Zaccagnini, RRT. BHSc. MSc (c)
Department of Anesthesia & Critical Care
McGill University Health Centre
“Where we have seen great successful with continuous monitoring is in our spinal cord population. Attempting to liberate these patients from the ventilator is a process which requires constant monitoring of their respiratory status. Although, we use saturations, work of breathing and Respiratory Rate, along with patient subjective responses to weaning trials, Endtidal CO2 monitoring is an objective tool to help us determine fatigue and respiratory compromise during weaning attempts. We use the upwards trending of endtidal CO2 to indicate respiratory muscle fatigue and we often see the increase in CO2 well before a decrease in SpO2. This helps us to appropriately assess the strength and condition of the patient’s respiratory muscles while ensuring the patient has adequate rest between weaning attempts. It also reduces the number of ABGs that are needed in patients while weaning from the ventilator.”
Andrea Wnuk, RRT
Vancouver Coastal Health
"I believe that continuous monitoring will allow respiratory therapists to catch some near-misses after patients have been liberated from the ventilator and transferred from ICU to the wards. In this environment, there are fewer staff per patient and often a lesser degree of surveillance. A good example would be a patient with a lower C-spine injury that is successfully weaned from the ventilator and does well for days or weeks on the ward, only to end up back in ICU a few days or weeks later in respiratory failure. When this happens, it's often because they are slowly and insidiously derecruiting and thus hypoventilating due to their injury, which is not detectable by even the most thorough respiratory assessments. Continuous CO2 monitoring could potentially tease out patients who are slowly failing, and we would know early to try methods such as nocturnal Bipap for rest and recruitment, sparing them an ICU visit."
Ingrid Hakanson, RRT