Meet the Game Changer

Another key event happened for me at the 2006 AARC National Congress. I felt pretty cool with my Conference ID badge with the yellow  "Speaker" ribbon attached. I gave three presentations that year. As I was wondering the vendor booths looking for and learning about the new and interesting technology especially relative to mechanical ventilation I encountered the booth of MediVent International from England. They are the UK distributor for United Hayek medical products and they had the Hayek RTX on display. If you haven't been introduced visit http://www.unitedhayek.com/.

There really is no way to describe the level of excitement I had for the product. I was introduced to the President of Respironics later that day. I don’t remember his  name, but I recall he asked me if I had seen anything that stood out as really exciting or special and I told him about the RTX. I told him Respironics should make a deal with them to bring it to the US.  I didn’t know, but at the time Respironics had the NEV 100 cuirass ventilator and had distributed the Hayek Oscillator when it came to the US. Both good products, but neither with the capabilities of the RTX.

During a brief period around 2002 I was the lead supervisor in a RT department at a teaching hospital. For the size of our facility I thought we had a large number of ARDS cases. I started looking into ways to improve on this and found the ARDS Net studies and recommendations. It became my mission to change the practice of our docs there at the time of using 10-12 ml/kg to something around half of that. We used a lot of volume targeted pressure control type of ventilation or PRVC, but generally at volume settings that were causing more problems. We had about half of our vents patients at some points on dialysis or continuous renal replacement therapy.  It was a major deal that took a lot of effort, but I finally started making some headway. It was still rare for us to get orders for PEEP > 10cm, but we did start seeing the VTs coming down some. We had one doc that liked to use HFOV as a rescue. Machine rental was pricey, so he saved it to last resort.  Usually the patients that we used it on wound up with renal failure and ultimately not making it. The few we had success on were electively paralyzed for such a long period that they wound up almost impossible to wean after they were returned to conventional vent settings. Whether it was PRVC or HFOV, patients  were usually laid out on Propofol or opioids or some version of narc coctails that would keep them somewhat settled in the bed with the low VTs and the severe dyspnic anxiety that accompanies ARDS. I have always kicked around ideas in my head about better ways to do things. I recall back then as I pondered the damage we were doing to our patient lungs first then other organ systems later with our ventilators thinking that some means of pulling the air into the patient’s lungs with a negative pressure ventilator, while still pushed with less pressure and potential of damage with a positive pressure vent while being able to monitor the volume exchange and exhaled gas data through a controlled airway and keep it all syched somehow would be a much better way. I remember giving my concept a term called the "Push Me, Pull You" mode.

When I encountered the Hayek RTX and they began explaining to me how it could be used as an adjunct to a positive pressure vent allowing essentially what I had envisioned years before and thus improving outcomes for ARDS patients I was awestruck. As the people in the booth went on to explain the other non-invasive uses and the multitude of  indications that BCV was beneficial for, how  it could facilitate weaning from PPV, it so clear and made so much sense.

Almost two years passed between that time and the approval of the RTX for use in the US. Four and half years passed between that time and my decision to leave bedside clinical practice in a hospital and join Hayek Medical as a clinical specialist. More than five years passed between that initial encounter and my first opportunity to see BCV applied clinically. I always knew it would be a useful clinical tool. I was surprised; however when I got to see what it was capable of. What I have seen it do for some very sick patients is why I say I have never seen any single device or therapeutic intervention that offers the same potential of altering the clinical course of patients with cardio-pulmonary compromise than BCV.

SPOY Maybe This is Why

So it was Fall of 05. As IT Manager I had a bit of a budget for education so I got approved to go to San Antonio to the AARC Convention along about then. I had to pay for my room and travel, but Kindred covered my tuition. I had not even worked in RT for some time, but I still wanted to keep up. I had added a membership to the Long Term Care Specialty Section when I renewed my AARC membership that year, and I had had some contact with the Chairperson and Chair elect prior to the conference so I was really looking forward to going since I would know some of the section members there.

In October of that year at my home facility we put together the policy and started educating on the new ICU rounds process. It was mainly to be an interdisciplinary discussion on each patient in the ICU and moved from bedside to bedside with the group. My role was to be facilitator of the process and monitor the RT staff for compliance with the weaning protocol. When we started we had 9 vents running. That was a bunch for this hospital. We had usually been a very aggressive weaning facility and got the vent admissions weaned in 1-2 weeks, but for some reason the vents were not getting off as in the past. The rounds became a daily process and became a part of the unit routines. Each day we would round at about 0900 and any patient that should be going on a spontaneous breathing trial that was not got to it. We worked through clinical issues as a team and the patients came off of their vents. By the first week in December when the conference rolled around even with a few vent admits being added, the facility was down to no vents in use and every vent admit and all of the 9 vent patient we started with were weaned. This might have happened anyway, but it sure felt good to be back in the ICU and doing what I loved.

As I mentioned before, the 2005 convention seems like a watershed event for me. I didn’t realize it at the time, I just had a great time and met some great folks. All I could talk about with everyone was our successful Grand Rounds, vent care and weaning. I have always been excited about RT, but with being deprived of that feeling of accomplishment that I have when I participate in the care of a vent patient who has failed to be separated from their vent successfully at the hands of a world class acute care hospital’s ICU team and their medical specialists and I am part of the successful effort had left me totally jazzed by my dip back into clinical care. I guess my excitement and passion came through at the conference. I have always appreciated the recognition, but I hardly worked clinically in 2006, but the Long Term Care Specialty Section selected me as the Specialty Practitioner of the Year for that year.