Cynthia Alexander, chief therapist of the respiratory care services department at Grady Health System in Atlanta, reviews the use of a portable ventilator with Venkata Donepudi, Melody Lanier, Sandra Jacobs and Derrick George, from left.

“Everyone has to breathe,” said Monica McBride, MBA, RRT, director of the respiratory therapy program at Griffin Technical College. It’s a fact most of us take for granted. Not so the respiratory therapist, whose job is to help people breathe when they can’t, due to illness or injury.

“One of the greatest satisfactions of being a respiratory therapist is that you always know that you are doing purposeful work,” McBride said.

“When there’s a code in the hospital, we’re there,” said Derrick George, BS, RRT-NPS, rehab and adult care supervisor of respiratory care at Grady Health System. “We’re in charge of the airway. If the patient needs to be intubated, then we do that and there’s a narrow window of time in which to work.

“Once the [oxygen providing] ventilator is hooked up, we continue to monitor the patient,” George said. “There’s stress — in that every situation is different — but we’re trained to respond.”

Confidence grows from working with so many different patients, said Lawrence Wade, BS, RRT, NPS, a neonatal specialist in DeKalb Medical Center’s neonatal intensive care unit. Experienced therapists develop critical analysis skills and can quickly
assess which product or device will be best for the patient.

An experienced respiratory therapist can make the job of cutting through the trachea to insert a tube connected to a ventilation machine look easy, but to the parents of a nonbreathing newborn, it’s a mindboggling experience, according Wade.

“A major part of our job in the neonatal nursery is keeping parents informed, to paint an accurate picture of what’s happening so that they are comfortable with the therapy. We go out of our way to provide education and comfort,” Wade said.

In less than 50 years, respiratory therapy has grown into an essential, high-tech health care field that touches a variety of clinical settings. The nation’s roughly 115,000 RTs have either a two-year or four-year degree. Most hold a certification (CRT) or registered (RRT) credential, and many have specialty training.

They work in all sectors of the health care arena, caring for patients under the direction of a physician in hospitals, nursing facilities, patient homes, pulmonary rehab clinics, sleep labs and transporting breathing assisted patients from one health care
facility to another.

Becoming a respiratory therapist offered Len McDade, RRT, NPS, MBA, a career that combined hisdesire to work directly with patients, his knowledge of science and his love of technology. Now the director of respiratory services at Northside
Hospital, McDade has watched the profession become more sophisticated and specialized.

“Through innovations in technology, research and the development of new medications, we’re able to take care of more patients with fewer resources,” he said. “Our machines are computerized and programmed to help us collect data. This allows us to
develop best practice protocols and practices.”

Many functions
Cynthia Alexander, MS, RRT-NPS, chief therapist, heads the respiratory care services department at Grady Health System, providing allhour coverage to all patient care floors and ICUs. The staff of 124 is cross-trained and covers plenty of territory, from working with anesthesiologists in the operating room to transporting critically-ill infants from rural Georgia.

Respiratory therapist Peter Smith moves a nitric oxide therapy apparatus to the neonatal intensive care unit at Grady Memorial Hospital. The machine helps decrease pulmonary hypertension in infants.

Besides providing oxygen therapy, airway management and ventilatory support, Grady therapists perform many functions.

“We can assist in the cardiac catherization lab and perform as extracorporeal membrane oxygenation technicians. In addition, we provide home care, staffing agencies, function as travel respiratory therapists, case managers and asthma educators,” Alexander said.

The respiratory care services department at Grady Health System is immersed in research.

“We’re also involved in cutting-edge research in sickle cell anemia, asthma, alternative ventilation methods for neonates and sleep disorders,” Alexander said. “We were recently awarded a grant from Homeland Security to purchase specialized ventilators for mass casualties. These machines will allow us to ventilate up to seven patients at a time.”

The education and training for RTs are ongoing.

“The learning never stops, because they keep improving the technology and treatment delivery methods,” said Sandra Jacobs, BS, RRT, RN, clinical specialist and respiratory technology services educator Grady.

George said that today’s equipment is often more compact, has easy-to-use features like touch screens, and collects more data. High-frequency oscillators, which deliver up to 60 breaths per minute, are saving the lives of patients who have air-leak injuries or ruptured lungs.

“The general trend is for therapists to use more noninvasive ventilation methods, because intubation causes volume and barotrauma. The longer patients are on ventilation, the more likely they are to develop complications like pneumonia or infection,” said Irma Seabrook, BS, RRT-NPS, nursery and transport supervisor at Grady Health System.

Helping babies breathe
“A lot of new research is coming from neonatal intensive care units,” Seabrook said.

Vapotherm is a non-invasive device that helps keep baby’s airways open. The high flow is administered through a cannula that fits into the nostrils.

Another innovation is the use of nitric oxide, a vasodilator, which increases ventilation perfusion and decreases pulmonary hypertension in infants.

“One of the greatest advances in respiratory therapy for neonates is surfactant, an artificial lung protein that keeps the alveoli open,” Wade said. “The body produces this protein naturally at 32 to 34 weeks of gestation, but not before. Previously, we had a high failure rate with 23- to 24-week-old preemies. They just weren’t viable, but surfactant has reversed that trend. It
gives preemies time for their lungs to develop and, nationally, we’re seeing more successes than failures.”

Lawrence Wade, a respiratory therapist at DeKalb Medical Center, checks the breathing of a preemie at the hospital’s neonatal intensive care unit.

As supervisor of the Grady Sleep Center and Pulmonary Function Testing Lab, Yvonne Tucker, MS, RPFT, works in one of the hottest specializations.

“Sleep medicine is a relatively new field, and there’s so much research coming out. They’re finding that disorders like sleep apnea are more common than we thought and is linked to other health problems,” she said.

Seeing their patients get better is the greatest job satisfaction for most respiratory therapists.For Seabrook, one of the highlights of the year is the Christmas reunion of her former neonatal patients.

“You see them come back and watch them grow and develop, these are the fruit of our labors,” she said.

“We see people come in from a wreck who can’t breathe, it’s a life or death situation,” George said. “When we see them walk out of here and go back to their normal lives, it feels great.”