The OPEN FORUM Series: D.C. Therapists Compare NICU Modalities

NICU Modalities
AARC members Cathy Hughes, left, and Gail Drescher are adding to the medical evidence on best practices for the delivery of noninvasive ventilation in the NICU.

Research presented during the annual Open Forum at the AARC Congress often attempts to answer the questions respiratory therapists have on the job every day.

That was true for the Editors’ Choice study comparing two different modalities in the NICU setting that was led by Gail Drescher, MA, RRT, CTTS, clinical specialist in the pulmonary services department at MedStar Washington Hospital Center in Washington, D.C., and presented in Indianapolis by her colleague and co-author Cathy Hughes, RRT.

Drescher explains how the study came about and what went into its development.

Why did you decide to conduct the study, “Comparison of the RAM Cannula to Conventional Bi-nasal Prongs in the Delivery of Noninvasive Respiratory Support to Very Low Birth Weight (VLBW) and Extremely Low Birth Weight (ELBW) Infants in the NICU.”? What piqued your interest in this topic?

Cathy Hughes, our NICU specialist, brought the RAM cannula to our hospital to replace the interfaces we were currently using to deliver noninvasive respiratory support. We needed to determine how well this new device was functioning, so we originally started collecting information as part of an ongoing PI project. As our preliminary results looked promising, we decided that we should more formally review this practice change.

Was this your first time conducting a research study? If not how many other studies have you conducted and where have you presented them or had them published?

This was not the first study I conducted, as my primary job is process improvement and research for the department. I have submitted several abstracts to the Open Forum, including one on epoprostenol use in the ICU, and another on the results of a grant project on COPD/asthma education through the D.C. Department of Health.

I was also part of the development of the pharmacologic and non-pharmacologic ACT clinical practice guidelines for the AARC, and wrote part of that publication for the Journal as well. I have had one original study published in Respiratory Care — “Incorporating Tiotropium Into a Respiratory Therapist-Directed Bronchodilator Protocol for Managing In-Patients With COPD Exacerbations Decreases Bronchodilator Costs.”

What did you do to gain support from your organization to conduct this study?

I spoke to our director, Ed Palmer, about budgeting time to conduct the study, then I had to go through MedStar’s IRB process to obtain approval to start our research. Cathy had to train staff in the use of the RAM, and it was her expertise that guided device implementation and the study topic.

What were the biggest challenges you faced as you carried out the study and how did you overcome them?

The most difficult challenge was just the amount of time it takes to conduct a clinical study. It’s very time consuming to collect and analyze data. Writing the actual manuscript also required the synthesis and integration of large amounts of data and previous research, as there were many important results and related topics that could have potentially influenced our final conclusions.

We overcame these challenges by prioritizing this research and putting other projects on hold. I also took research home to review and write off-hours in order to meet certain deadlines.

How difficult was it to work the study into your normal job responsibilities and how did you alter your work routine to make it happen? Do you think it was worth the time and effort?

It required the suspension of other job responsibilities, at times, as well as prioritizing what needed to be completed each work day. It was absolutely worth the time and effort as it produced interesting work we hope to build upon. It also demonstrated to hospital leadership the vital role that RTs play in clinical management.

How did it feel to learn that your abstract had been accepted to the Open Forum — and most especially, that it was selected for the Editors’ Choice session?

We were both very excited to learn it was selected for the Editors’ Choice — it was a complete surprise, and very much an honor. Cathy is an excellent clinician and I think it showed that her hard work and innovation in the NICU had paid off in very meaningful ways for the vulnerable patients she treats. Without this research, the overall effects of implementing the RAM would have remained unknown.

How do you think conducting a study like this and having it accepted to the Open Forum is helping to further your career in respiratory care?

Research is not something that is widespread among RTs, I don’t think, so being able to perhaps impact practice in our profession is an ultimate career goal. I believe it shows the diverse roles RTs can have in health care.

What advice do you have for other therapists who might like to follow in your footsteps but just don’t know how to get started?

I would advise therapists to try to find a way to implement research in their department. Talk to departmental leadership and ask whether this is something they are interested in supporting. It may help to show how a study can benefit the department and hospital. Administration is interested in work that demonstrates clinical or financial advantages, so collecting preliminary data prior to a larger study may be useful.

Having an advanced degree as an RT helps, but if not, most hospitals have research departments that can assist with study design and analysis of data. Become familiar with the literature and unanswered questions that may be of clinical value to the specific patient population that a hospital treats. This information can then help in topic selection. But in general, start small, and build.

Are you planning to conduct more studies in the future? If so, what will you study next and why?

Yes, Cathy and I would like to continue research with the RAM, and we are currently studying carbon dioxide regulation in premature infants. We chose this topic because carbon dioxide levels and fluctuations in PCO2 have been implicated in the development of intraventricular bleeds and neuro-developmental impairment in premature infants. RTs play a primary role in ventilator management, and therefore are in a position to potentially influence important outcomes.

2017 Open Forum Abstracts

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