I work a regional trauma center and our docs are totally behind the times.Our docs are not proactive in learning new things pertaining to ventilation and if they are they surely aren't practicing it.
1. We still put some acute patients on simv
2. We use mostly cmv(drager xl) with vt 10 ml/kg ibw and +5 of peep. If we do use more than +5 our docs first objective is to decrease the peep to +5.Sometimes won't order more peep till pt is on 100% with poor po2's
3.Docs won't use APRV.
4.Docs want weans to go for hours on end with no plan to extubate(bid to 12hrs).
5.Docs still order weans of psv +10 and peep +5, despite ATC.
6.Docs won't order recruitment on patients with bibasilar atelectasis.
This is a very frustating place to work at times for a proactive RRT. What is a therapist to do? How do you get pulmonary docs to change their ways? How did all of you get to the 21st century of ventilation?
Chris Hanson RN, RRT-NPS, CPFT, AE-C
ER Registered Nurse
Grand Junction, Colorado
I feel your pain. About five years ago I had the same problem. I worked in a 300+ bed regional hospital. We used the origan Draeger vents and were looking at new models, we demo'ed the PB840, Servoi, DraegerXL. We chose the best, the XL. We had twelve pulmonary doc's and maybe two would use small VT high rate. One day in the ICU a pulm doc was talking to a nurse and said "I don't know what else to do". I overheard and said that I do. I suggested APRV and he said ok. I also suggested that we call ICON and he talk to DR Habashi. He did and APRV work great for the client(didn't change outcome, but he was impressed). The rest of the physicians eventually followed suit. This didn't happen without opposition. One of the older pulm doc's said that APRV has been around since the 80's, which is true. He was right but not "Habashi APRV". In the 80's we did not have Draeger's active exhalation valve and ATC. What you need is one physician champion to use APRV correctly. I believe that research will show that APRV/BILEVEL is supieror to ARDSnet protocol(small VT and high rate). Erlanger in Chattonooga, TN is researching and to my knowledge is not yet published.
I have the fortune of working at the U of M Medical Center in Ann Arbor, Michigan and the doctors there are on the cutting edge of technology and aren't afraid to use it. The hospital has the money to invest in new treatment modalities, new vents, etc. and actually listen to the RTs when it comes to how best to ventilate our patients.
I've been in your shoes more times then I care to mention. Unfortunately we happen to be our own worst enemies (We being RTs). It's nothing to be proud of but I've been terminated from a few jobs in my life and crusty old physicians are the main reason. We need more RT's who are willing to speak up and not worry that they might rock the boat. I follow a simple rule...do what's right for the patient and whatever happens at least I can sleep at night. Show a little passion for you work and figure out how to get your point across without stepping on to many toes.
Whatever you do don't let them turn you into a zombie RT who's main objective each day is to get his Q4 vent checks done.
Check out http://www.pulmonaryreviews.com/march02/myway.html
Well educated, trained and informed RCPs are the most powerful force for the application of cutting edge care in the healthcare industry. The greatest source of burnout for this group is physicians, nurses and administrators who do not realize this and treat us accordingly. Arm yourself with up to date data, be ready when they are stumped and show them what you can do. If you are not getting that opportunity routinely or you think you never will you might want to move on or just give up and go mindless (not recomended)The science really works. Why these crusty old school docs choose not to recognize that is very frustrating. We feel your pain. Good luck GJ,RRT. Keep posting and keep us posted.
I understand your frustration. Is your center a teaching facility?
I've learned that working at a teaching facility allows you to be more PROACTIVE in newer modalities/therapies.
When we got new Servo i's, the first thing I wanted to learn was BiVent. We were using 300's before, so no comparison.
It's been about a year and half and now, when a trauma doc or pulm doc asks me "How come bed# isn't on BiVent, I get chills.LOL!
fztella mentioned above:
"Show a little passion for you work and figure out how to get your point across without stepping on to many toes".
What a great statement!
And Gary stated:"Arm yourself with up to date data, be ready when they are stumped and show them what you can do".
Well said Gary. That golden moment to shine and show them what you can do....you will be rewarded.
The day I stop getting chills at work...I'll turn in my license.
Good luck and hang in there!
I have seen this syndrome before GJ,
Since you may only hunt down cranky olde physicians during the corect season, and cattle have been banned in some states, it is fair to say that with any physician success and objectives can be obtained by letting the "teah you".
What I mean to say is to load up on current trends, data and community standards and discuss what you have been learning with what their practice is.
The are still alot of the "crusty" generation around and they feel threatened by what we are really doing. Good strong evidenced based protocols and a young gun to champion them is the best palce to start.
Figure out how much longer that the older Drs. will still be in practice and focus on their replacments. You have to accept the fact that sometimes you can't teach an old dog new tricks.