Background: Respiratory care departments are experiencing an increased need to demonstrate value in the care they deliver. Value efficiency is a concept that incorporates the value of individual treatments into the normal operations of a department. The purpose of this study was to describe respiratory care leaders' attitudes about the value of services provided by respiratory care departments. Methods: An electronic survey was distributed via social media, professional networks, and a manager work group. The survey was targeted to directors, managers, and supervisors of respiratory care departments. We asked questions related to value, services, and barriers to implementation of value efficiency. Data analysis was descriptive. Results: We received 116 responses; 86% were from managers or directors. The 5 most valuable services delivered were invasive mechanical ventilation (82%), noninvasive ventilation or CPAP (71%), protocol-driven care (47%), code team (44%), and rapid response team (41%). The 5 least valuable services delivered by respiratory care departments were electrocardiograms (63%), stress testing (44%), lung expansion therapies (41%), sleep studies staffed by the respiratory care department (36%), and smoking cessation education (36%). The primary barrier to value efficiency was physician prescribing practices (68%). There was general agreement that physicians support respiratory therapy protocols (71%), value should be considered when evaluating respiratory care services (95%), and directing resources to more valuable services if possible (73%). Respondents did not agree that hospital administrators understand respiratory therapy workflow and full-time equivalent needs (35%) nor that hospital administrators would be supportive if we reduced services (18%). Conclusions: In a small sample of respiratory therapy leaders, there was limited consensus on what respiratory care services are the most and least valuable. Lack of consensus on high- and low-value services and physician prescribing practice were the primary barriers to value efficiency. Nearly all respondents felt value should be considered when evaluating respiratory care services.

Introduction Right heart catheterization (RHC) can be used to measure resting cardiac output in acute decompensated heart failure, with measurements based on the Fick Principle (Oxygen consumption = Cardiac Output x ∆Arterio-venous O2 content difference). While direct measurement of resting oxygen consumption (VO2) is the gold standard, this is not routinely performed due to cumbersome equipment and time limitations, leading to reliance on estimation equations or thermodilution-based CO determinations. However, the accuracy of these alternative methods in a contemporary inpatient heart failure population is unknown. Hypothesis We hypothesized that the estimated Fick (eFick) and Td would overestimate cardiac index (CI) as compared with the direct measured VO2 Fick (dFick) in patients admitted for suspected cardiogenic shock undergoing RHC. Methods We prospectively enrolled a convenience sample of inpatients with heart failure undergoing RHC who volunteered to have direct VO2 measurement undertaken from June 2022 through January 2023. eVO2 was determined using the Dehmer method (125*body surface area). VO2 was directly measured by metabolic cart (Carefusion N29 Vmax)using the canopy method. dFick, eFick, and Td measurements were compared using linear regression and Bland-Altman plots. Results Nine patients underwent direct VO2 measurement and RHC. Seven patients were male (77.8%), 8 (88.9%) had reduced ejection fraction (<50%), and ages ranged from 42-76 years. eVO2 overestimated measured resting VO2 in all 9 patients (mean difference 28.1±17.1 mL O2/min). The mean CI were dFick: 1.8±0.6, eFick: 2.1±0.8, Td: 1.9±0.8 L/min/m2. eFick overestimated CI by 14±9%, and Td overestimated CI by 6±16%, as compared to the dFick determination of CI. While eFick had higher precision for CI than Td, Td had higher accuracy. Body mass index correlated with the difference in CI between Td and dFick (r = 0.85, p<0.01), but not for difference in CI between eFick and dFick (r = 0.27, p = 0.49). No correlation with difference in CI was observed between either Td and dFick or eFick and dFick for age, ejection fraction, tricuspid regurgitation severity, mitral regurgitation severity, left ventricular internal diameter at end diastole, pulmonary capillary wedge pressure, or pulmonary artery pulsatility index. Conclusion eFick and Td methods for invasive hemodynamics generally overestimate CI compared with directly measured resting VO2 using a metabolic cart in a contemporary heart failure population. Further study should determine whether use of routine direct VO2 measurement impacts clinical outcomes.

Despite prior publications of clinical practice guidelines related to ventilator liberation, some questions remain unanswered. Many of these questions relate to the details of bedside implementation. We, therefore, formed a guidelines committee of individuals with experience and knowledge of ventilator liberation as well as a medical librarian. Using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, we make the following recommendations: (1) We suggest that calculation of a rapid shallow breathing index is not needed to determine readiness for a spontaneous breathing trial (SBT) (conditional recommendation; moderate certainty); (2) We suggest that SBTs can be conducted with or without pressure support ventilation (conditional recommendation, moderate certainty); (3) We suggest a standardized approach to assessment and, if appropriate, completion of an SBT before noon each day (conditional recommendation, very low certainty); and (4) We suggest that FIO2 should not be increased during an SBT (conditional recommendation, very low certainty). These recommendations are intended to assist bedside clinicians to liberate adult critically ill patients more rapidly from mechanical ventilation.

Mechanical ventilation is ubiquitous in critical care, and duration of ventilator liberation is variable and multifactorial. While ICU survival has increased over the last two decades, positive-pressure ventilation can cause harm to patients. Weaning and discontinuation of ventilatory support is the first step in ventilator liberation. Clinicians have a wealth of evidence-based literature at their disposal; however, more high-quality research is needed to describe outcomes. Additionally, this knowledge must be distilled into evidence-based practice and applied at the bedside. A proliferation of research on the subject of ventilator liberation has been published in the last 12 months. Whereas some authors have reconsidered the value of applying the rapid shallow breathing index in weaning protocols, others have begun to investigate new indices to predict liberation outcomes. New tools such as diaphragmatic ultrasonography have begun to appear in the literature as a tool for outcome prediction. A number of systematic reviews with both meta-analysis and network meta-analysis that synthesize the literature on ventilator liberation have also been published in the last year. This review describes changes in performance, monitoring of spontaneous breathing trials, and evaluations of successful ventilator liberation.

BACKGROUND:Leadership is critical to high-functioning teams; however, data are lacking for what defines successful respiratory therapist (RT) leadership. Leaders need a wide range of skills to be successful, although the exact characteristics, behaviors, and accomplishments of successful RT leaders are unknown. We performed a survey of respiratory care leaders to evaluate different aspects of RT leadership.METHODS:We developed a survey of RT leaders to examine respiratory care leadership in a variety of professional settings. Different aspects of leadership and the relationships between perceptions of leadership and well-being were assessed. Data analysis was descriptive.RESULTS:We received 124 responses, with a response rate of 37%. Respondents had a median 22 y of RT experience, and 69% were in leadership positions. The most-important skills identified for potential leaders were critical thinking (90%) and people skills (88%). Self-initiated projects (82%), intradepartmental education (71%), and precepting (63%) were noted accomplishments. Reasons for exclusion from leadership included poor work ethic (94%), dishonesty (92%), difficulty getting along with others (89%), unreliable (90%), and not being a team player (86%). Most respondents (77%) agreed American Association for Respiratory Care membership be a requirement for leadership; however, 31% required membership. Integrity (71%) was noted consistently as a characteristic of successful leaders. There was no consensus for behaviors of successful versus unsuccessful leaders or what defines successful leadership. Ninety-five percent of leaders had received some leadership training. Respondents reported that well-being is affected by leadership, departmental culture, peers, and leaders with burnout; 34% of respondents felt people with burnout received good support at their institution, whereas 61% felt maintaining well-being is left to individuals.CONCLUSIONS:Critical thinking and people skills were the most-important skills for potential leaders. Limited consensus existed on characteristics, behaviors, and defined success of leaders. Most respondents agreed leadership influences well-being.

Burnout is a major problem in health care and is associated with adverse sequelae for patients, health care workers, and organizations. Burnout among respiratory therapists (RTs) is as high as 79% and is associated with poor or ineffective leadership, inadequate staffing, high work load, non-leadership position, and work environment. An understanding of burnout is neces-sary for both staff and leadership to ensure RT well-being. This narrative review will discuss the psychology of burnout, prevalence, drivers, mitigation strategies, and future directions for research.

OBJECTIVES:. Physiological decompensation of hospitalized patients is common and is associated with substantial morbidity and mortality. Research surrounding patient decompensation has been hampered by the absence of a robust definition of decompensation and lack of standardized clinical criteria with which to identify patients who have decompensated. We aimed to: 1) develop a consensus definition of physiological decompensation and 2) to develop clinical criteria to identify patients who have decompensated. DESIGN:. We utilized a three-phase, modified electronic Delphi (eDelphi) process, followed by a discussion round to generate consensus on the definition of physiological decompensation and on criteria to identify decompensation. We then validated the criteria using a retrospective cohort study of adult patients admitted to the Hospital of the University of Pennsylvania. SETTING:. Quaternary academic medical center. PATIENTS:. Adult patients admitted to the Hospital of the University of Pennsylvania who had triggered a rapid response team (RRT) response between January 1, 2019, and December 31, 2020. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Sixty-nine experts participated in the eDelphi. Participation was high across the three survey rounds (first round: 93%, second round: 94%, and third round: 98%). The expert panel arrived at a consensus definition of physiological decompensation, “An acute worsening of a patient’s clinical status that poses a substantial increase to an individual’s short-term risk of death or serious harm.” Consensus was also reached on criteria for physiological decompensation. Invasive mechanical ventilation, severe hypoxemia, and use of vasopressor or inotrope medication were bundled as criteria for our novel decompensation metric: the adult inpatient decompensation event (AIDE). Patients who met greater than one AIDE criteria within 24 hours of an RRT call had increased adjusted odds of 7-day mortality (adjusted odds ratio [aOR], 4.1 [95% CI, 2.5–6.7]) and intensive care unit transfer (aOR, 20.6 [95% CI, 14.2–30.0]). CONCLUSIONS:. Through the eDelphi process, we have reached a consensus definition of physiological decompensation and proposed clinical criteria with which to identify patients who have decompensated using data easily available from the electronic medical record, the AIDE criteria.

BACKGROUND: Recent studies have revealed high rates of burnout among respiratory thera-pists (RTs), which has implications for patient care and outcomes as well as for the health care workforce. We sought to better understand RT well-being during the COVID-19 pandemic. The purpose of this study was to determine rates and identify determinants of well-being, including burnout and professional fulfillment, among RTs in ICUs. METHODS: We conducted a mixed -methods study comprised of a survey administered quarterly from July 2020-May 2021 to criti-cal-care health care professionals and semi-structured interviews from April-May 2021 with 10 ICU RTs within a single health center. We performed multivariable analyses to compare RT well-being to other professional groups and to evaluate changes in well-being over time. We ana-lyzed qualitative interview data using thematic analysis, followed by mapping themes to the Maslow needs hierarchy. RESULTS: One hundred eight RTs responded to at least one quarterly survey. Eighty-two (75%) experienced burnout; 39 (36%) experienced professional fulfillment, and 62 (58%) reported symptoms of depression. Compared to clinicians of other professions in multivariable analyses, RTs were significantly more likely to experience burnout (odds ratio 2.32 [95% CI 1.41-3.81]) and depression (odds ratio 2.73 [95% CI 1.65-4.51]) and less likely to expe-rience fulfillment (odds ratio 0.51 [95% CI 0.31-0.85]). We found that staffing challenges, safety concerns, workplace conflict, and lack of work-life balance led to burnout. Patient care, use of specialized skills, appreciation and a sense of community at work, and purpose fostered profes-sional fulfillment. Themes identified were mapped to Maslow's hierarchy of needs; met needs led to professional fulfillment, and unmet needs led to burnout. CONCLUSIONS: ICU RTs experienced burnout during the pandemic at rates higher than other professions. To address RT needs, institutions should design and implement strategies to reduce burnout across all levels.

Providing supplemental oxygen to hospitalized adults is a frequent practice and can be administered via a variety of devices. Oxygen therapy has evolved over the years, and clinicians should follow evidence-based practices to provide maximum benefit and avoid harm. This systematic review and subsequent clinical practice guidelines were developed to answer questions about oxygenation targets, monitoring, early initiation of high-flow oxygen (HFO), benefits of HFO compared to conventional oxygen therapy, and humidification of supplemental oxygen. Using a modification of the RAND/UCLA Appropriateness Method, 7 recommendations were developed to guide the delivery of supplemental oxygen to hospitalized adults: (1) aim for [Formula: see text] range of 94-98% for most hospitalized patients (88-92% for those with COPD), (2) the same [Formula: see text] range of 94-98% for critically ill patients, (3) promote early initiation of HFO, (4) consider HFO to avoid escalation to noninvasive ventilation, (5) consider HFO immediately postextubation to avoid re-intubation, (6) either HFO or conventional oxygen therapy may be used with patients who are immunocompromised, and (7) consider humidification for supplemental oxygen when flows > 4 L/min are used.

BACKGROUND: Burnout is a major challenge in health care and is associated with poor overall well-being, increased medical errors, worse patient outcomes, and low job satisfaction. There is scant literature focused on the respiratory therapist’s (RT) experience of burnout, and a thorough exploration of RTs’ perception of factors associated with burnout has not been reported. The aim of this qualitative study was to understand the factors associated with burnout as experienced by RTs amid the COVID-19 pandemic. METHODS: We performed a post hoc, qualitative analysis of free-text responses from a survey of burnout prevalence in RTs. RESULTS: There were 1,114 total and 220 free-text responses. Five overarching themes emerged from the analysis: staffing, workload, physical/emotional consequences, lack of effective leadership, and lack of respect. Respondents discussed feelings of anxiety, depression, and compassion fatigue as well as concerns that lack of adequate staffing, high workload assignments, and inadequate support from leadership contributed to feelings of burnout. Specific instances of higher patient acuity, surge in critically ill patients, rapidly evolving changes in treatment recommendations, and minimal training and preparation for an extended scope of practice were reported as stressors that led to burnout. Some respondents stated that they felt a lack of respect for both the RT profession and the contribution of RTs to patient care. CONCLUSIONS: Themes associated with burnout in RTs included staffing, workload, physical and emotional exhaustion, lack of effective leadership, and lack of respect. These results provide potential targets for interventions to combat burnout among RTs.

BACKGROUND:In the course of their education, respiratory therapy students participate in clinical rotations, which are essential to their education. Recently, the number of clinical sites has decreased as some have been eliminated. During the COVID-19 pandemic, schools were challenged to find hospitals to accommodate students due to the risk of infection. Tele-ICU has emerged as a means for staff therapists to assess and monitor patients via remote monitoring systems. We hypothesized that a clinical rotation at a tele-ICU would strengthen students' knowledge of mechanical ventilation, telemedicine, and COVID-19.METHODS:In this study, students completed clinical rotations in a tele-ICU. Students spent two 4-h clinical rotations rounding on 320 ICU beds at 5 hospitals. Under the supervision of experienced therapists, students performed remote patient-ventilator assessments, including review and interpretation of ventilator waveforms, patient-ventilator interaction, arterial blood gases, and chest x-rays. Students completed pre- and post-rotation surveys assessing their confidence managing mechanical ventilation, experience with telemedicine, ARDS, and patients with COVID-19.RESULTS:Mean self-confidence in mechanical ventilation (P = .001), assessing waveforms (P = .001), and knowledge of ARDS increased after the clinical rotation (P = .001). Similarly, reported knowledge related to spontaneous breathing trial protocols (P = .009), lung-protective ventilation (P = .002), patient care planning (P = .001), and use of Excel spreadsheets (P = .002) increased from the beginning to the end of the clinical rotation. Student confidence in interprofessional communication increased from 85 [69-98] to 95 [78-100]; P = .03). Overall, the largest change was students' ability to assess patients with COVID-19 (pre-rotation 50.0 [11.5-65.7], post-rotation 80.0 [58.5-100]; P = .001). Qualitative results revealed overwhelmingly positive results for both students and preceptors.CONCLUSIONS:Students' confidence in assessing patients via remote monitoring increased in a tele-ICU clinical rotation. Self-assessed knowledge related to COVID-19 also increased to statistical significance.

From the Authors: We would like to thank Dr Hatipoğlu for his interest in our recently published clinical practice guidelines for the management of adult patients with oxygen in the acute care setting.[1][1] We would first like to clarify that the inclusions of the SpO2 target of 88–95% for

BACKGROUND: Burnout within health care is prevalent, and its effects are detrimental to patient outcomes, organizations, and individuals. Effects stemming from burnout include anxiety, depression, excessive alcohol and drug use, cardiovascular problems, time off work, and worse patient outcomes. Published data have suggested up to 50% of health care workers experience burnout and 79% of respiratory therapists (RTs) experience burnout. Leadership has been cited as a key driver of burnout among RTs. We aimed to identify factors associated with a positive or negative leadership perception. METHODS: A post hoc analysis of an institutional review board-approved survey to evaluate RT burnout, administered via REDCap by convenience sample to 26 health care centers (3,124 potential respondents) from January 17-March 15, 2021, was performed to identify factors associated with a positive view of leadership. Survey questions included validated tools to measure leadership, burnout, staffing, COVID-19 exposure, and demographics. Data analysis was descriptive, and logistic regression was performed to evaluate factors associated with leadership perception. RESULTS: Of 1,080 respondents, 710 (66%) had a positive view of leadership. Univariate analysis revealed those with a positive view of leadership were more likely to be working with adequate staffing, were rarely unable to complete all work, were less likely to be burned out, disagreed that people in this work environment were burned out, were less likely to miss work for any reason, more likely to be in a leadership position, worked fewer hours in intensive care, worked in a center affiliated with a medical school, worked day shift, were less likely to care for adult patients, and were more likely to be male. Logistic regression revealed providing care to patients with COVID-19 (odds ratio [OR] 5.8-10.5, P < .001-.006) was the only factor associated with a positive view of leadership, whereas working without adequate staffing (OR 0.27-0.28, P = .002-.006), staff RTs (OR 0.33, P <.001), work environment (OR 0.42, P = .003), missing work for any reason (OR 0.69, P = .003), and burnout score (OR 0.98, P <.001) were associated with a negative view of leadership. CONCLUSIONS: Most RTs had a positive view of their leadership. A negative leadership score was associated with higher burnout and missing work. This relationship requires further investigation to evaluate if changes in leadership practices can improve employee well-being and reduce burnout.

A 24/7 telemedicine respiratory therapist (eRT) service was set up as part of the established University of Pennsylvania teleICU (PENN E-LERT®) service during the COVID-19 pandemic, serving five hospitals and 320 critical care beds to deliver effective remote care in lieu of a unit-based RT. The eRT interventions were components of an evidence-based care bundle and included ventilator liberation protocols, low tidal volume protocols, tube patency, and an extubation checklist. In addition, the proactive rounding of patients, including ventilator checks, was included. A standardized data collection sheet was used to facilitate the review of medical records, direct audio–visual inspection, or direct interactions with staff. In May 2020, a total of 1548 interventions took place, 93.86% of which were coded as “routine” based on established workflows, 4.71% as “urgent”, 0.26% “emergent”, and 1.17% were missing descriptors. Based on the number of coded interventions, we tracked the number of COVID-19 patients in the system. The average intervention took 6.1 ± 3.79 min. In 16% of all the interactions, no communication with the bedside team took place. The eRT connected with the in-house respiratory therapist (RT) in 66.6% of all the interventions, followed by house staff (9.8%), advanced practice providers (APP; 2.8%), and RN (2.6%). Most of the interaction took place over the telephone (88%), secure text message (16%), or audio-video telemedicine ICU platform (1.7%). A total of 5115 minutes were spent on tasks that a bedside clinician would have otherwise executed, reducing their exposure to COVID-19. The eRT service was instrumental in several emergent and urgent critical interventions. This study shows that an eRT service can support the bedside RT providers, effectively monitor best practice bundles, and carry out patient–ventilator assessments. It was effective in certain emergent situations and reduced the exposure of RTs to COVID-19. We plan to continue the service as part of an integrated RT service and hope to provide a framework for developing similar services in other facilities.

Background: During the COVID-19 pandemic, we initiated a new clinical rotation for respiratory care students in a virtual ICU (eICU). During this rotation, students experienced an increase in their baseline knowledge of telemedicine and mechanical ventilation. We hypothesized that qualitative feedback of the clinical rotations would reflect a positive learning experience. Methods: Students from two universities completed clinical rotations in a tele-ICU as a part of an IRB-approved observational study. They completed two, four-hour rotations with a telemedicine RT preceptor (eRT) with experience in the eICU. Students were involved in remote patient assessment, review and interpretation of ventilator waveforms, blood gases, and chest x-rays. Students received an introduction to lung protective ventilation, spontaneous breathing, and broncho-pulmonary hygiene protocols. At the end of the second day of the clinical rotation, students completed a survey which included qualitative questions regarding their experience. Results: In their comments, students stated eRTs provided guidance and created a comfortable learning environment that students would recommend to others. Interaction with tele-ICU RNs (eRN) was described as friendly, knowledgeable, and helpful. Students noted the high level of teamwork in the eICU and that they observed quality patient care provided. Students stated that interactions with tele-ICU MDs were educational; however, forty percent of students reported not interacting with eMDs. While some of the students did not interact with staff in the physical ICU, others noted that interactions via telecommunication platforms were positive and friendly. The biggest difference noted between this rotation and in-person rotations was that it is not hands on; however, students stated they were able to focus on technology and learning about ventilator waveforms and mechanics. When asked what it takes to be an effective eRT, a willingness to learn and be involved was described. Students felt it was important to be knowledgeable about technology, modes of mechanical ventilation, and waveforms. Additionally, the students noted it was important to be knowledgeable about diseases and patient-ventilator synchrony. Conclusions: Students’ experience in a virtual ICU was overwhelmingly positive, providing new perspectives on patient care.

Background: Respiratory Therapy is moving toward baccalaureate degree as the standard for new graduates to enter the profession. Differences have been noted in the curriculums within associate and bachelor’s degree programs. To our knowledge, there is currently no data comparing orientation outcomes in associate degree versus bachelor degree graduates. We sought to compare new graduate orientations in hospital settings. Methods: After approval from IRB, a request to participate in data collection was sent to 181 RT managers Pennsylvania. Each center was asked to complete a survey on their orientation process, attend a call on the study to learn operational definitions and data collection methods for new graduates completing orientation. A data entry log was provided to collect the required information until each individual completed orientation for entry into the database. For comparison between groups we included only the extra hours spent on general care orientation beyond institutional standard as it was anticipated that dedicated orientation time would vary. Results: Fourteen hospitals agreed to participate. Of those, 8 (57%) returned data on 55 new graduate RTs from May 2019 – September 2020. Five individuals terminated before the end of the orientation process were not included in the analysis. Twenty-six RTs earned an associate degree and 24 earned a baccalaureate degree. RTs with an associate degree spent a total 340 extra hours on general care orientation versus those with a bachelor’s degree, who spent a total of 656 extra hours. A combined mean of 216 extra hours was spent on general care orientation. Individuals with associate degrees spent a mean 34 ± 21.44 extra hours. Bachelor’s degree earners spent a mean 51.2 ± 21.33 extra hours orienting to general care. The mean difference between groups was 17.2 hours (P = 0.178). Thirty-two individuals included (64%) were new hires from a free-standing children’s hospital in an urban center and likely heavily skews the data as their educational needs may greatly differ from the other institutions. Conclusions: Differences in extra hours spent in orientation between newly hired associate degree and bachelor’s degree RTs did not differ statistically. However, differences in orientation programs likely contribute and should be unified for future investigations.

Background: Burnout among respiratory therapists (RTs) has been reported as high as 72% during the COVID-19 pandemic. Limited data are available regarding wellness and fulfillment among RTs. The purpose of this study was to conduct interviews to explore burnout, wellness, and fulfillment among RTs working in critical care during the COVID-19 pandemic and to inform future decisions for potential interventions to reduce burnout and increase feelings of fulfillment. Methods: We conducted semi-structured interviews to learn about RTs experience of burnout, wellness, and job fulfillment during the pandemic. Recruitment occurred from April – May 2021 in a single academic, tertiary care medical center. We recruited staff RTs by including study information in a biweekly email and on flyers posted throughout workspaces. A single research coordinator conducted all interviews via videoconference or telephone. Participants received a $50 gift card in compensation for their time. All interviews were recorded and transcribed for analysis. Two of the authors identified themes using open coding. The study was approved by the University of Pennsylvania IRB. Results: Seven RTs participated in interviews. Median experience in the field was 16 (4.5-27) years. Respondents felt that burnout was driven by lack of staffing, challenges of working during the COVID-19 pandemic, and the emotional toll of caring for patients who were extremely ill. Factors reported to improve wellness included: working consistently in the same units, participating in committees, and professionalism among colleagues. Respondents felt fulfilled by building relationships with colleagues, having the ability to teach new colleagues and learn new skills, caring for patients and seeing them progress, and being appreciated by MDs, other staff, and patients. Regarding interventions to reduce burnout and improve wellness, respondents reported that they appreciated interactions with colleagues and camaraderie of celebrations, which were limited during the pandemic. However, the most consistent recommended intervention was to reduce staff shortages. Conclusions: RTs experienced high levels of burnout during the COVID-19 pandemic. Coping mechanisms, such as interactions and celebrations with their colleagues, were interrupted due to pandemic policies. Interventions to provide more staffing and increased peer interactions may mitigate the severe burnout experienced by this group.

Background: Clinical rotations are essential to respiratory therapy students (RTS) learning objectives. The COVID-19 pandemic profoundly affected RTS education by limiting their bedside exposure, as they were prohibited from caring for COVID-19 patients. Here we describe a clinical rotation at a tele-ICU (eICU) which gave RTS access to COVID-19 patients. Our goal was to increase their knowledge of the disease process to better prepare them for the workforce. Methods: Students from two universities completed clinical rotations in a tele-ICU as a part of an IRB-approved observational study. They completed two, four-hour rotations with an experienced telemedicine RT preceptor (eRT) in the eICU. Data collection occurred from February 2021 – May 2021. Along with their preceptors, RTS rounded on 320 ICU beds across five hospitals. Primary objectives of the clinical rotation included performing remote patient assessments, interpreting ventilator waveforms, arterial blood gases, and chest x-rays. RTS received education on lung protective ventilation and spontaneous breathing protocols. During ventilator rounds, RTS filled out demographic surveys to identify the complexity and diversity of the patient population. Results: Thirty-three RTS included in the study rounded on 370 patients during their remote clinical rotations. Of the patients RTS interacted with, 57% (n = 211) identified as male. Mean age of the population was 52.5 ± 18. Racial make-up closely resembled the diversity in the region with 39% (n = 145) Black and 50% (n = 183) white patients. Ninety-two percent of the patients were mechanically ventilated and RTS completed 239 patient-ventilator assessments. The primary disease processes of patients seen were ARDS (n = 178) and COVID-19 (n = 145). In patients with ARDS, 36% (n = 65) required follow-up due to issues related to adherence to protocol. Volume-targeted modes of ventilation were most commonly used, 47% (n = 175). Patient interventions included 73 instances of worsening symptoms on mechanically ventilated patients. Twenty-eight patients were deemed high risk airways which required increased surveillance. Conclusions: During this remote clinical rotation, RTS had the opportunity to interact with and complete assessments on patients diagnosed with COVID-19. This rotation prepared RTS to care for a diverse patient population via the eICU and increase their knowledge and experience with COVID-19 patients despite a lack of traditional hands-on experience.