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BACKGROUND: Burnout is a major problem in health care, with rates of approximately 33% and 50% in nurses and physicians, respectively, prior to the COVID-19 pandemic. Respiratory therapist (RT) burnout rates and drivers have not been specifically examined. The purpose of this project was to determine resilience and burnout resources available within respiratory care departments and to provide an estimate of pre-and post-COVID-19 RT burnout rates. METHODS: A survey was developed to evaluate resilience and burnout resources in respiratory care departments. The survey was posted online to the AARConnect management, education, adult acute care, neonatal/pediatrics, COVID-19, and help line communities. Data analysis was descriptive. Key drivers of burnout among RTs were identified from qualitative answers. RESULTS: There were 221 responses, and 72% reported experiencing burnout. Ten percent of the departments that responded measured burnout; 36% utilized resilience tools, and 83% offered free employee assistance for those struggling with burnout. In January 2020, 30% of departments reported an estimated burnout rate > 40%, which increased to 44% of departments (P 5 .007) in the COVID-19 pandemic period. The most common drivers reported were poor leadership (32%), high work load (31%), and staffing (29%); 93% of respondents agreed that burnout is a major problem in health care, 33% agreed that burnout is primarily driven by external factors, 92% agreed that RTs have a similar risk of burnout as other health care professionals, 73% agreed that they were comfortable discussing challenging situations with colleagues, 32% agreed that their leadership provided adequate support for those suffering from burnout, and 79% agreed that they would be open to utilizing resilience tools from the AARC or other professional organizations. CONCLUSIONS: Most respondents experienced burnout and few respiratory care departments measured burnout. Resilience resources were not commonly used but employee assistance and wellness programs were common. Key drivers of burnout identified were poor leadership, staffing, and high workloads.

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 S pO 2 range of 94-98% for most hospitalized patients (88-92% for those with COPD), (2) the same S pO 2 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: The Pennsylvania Respiratory Research Collaborative formed in January 2017 for the purpose of providing mentorship and opportunities to participate in statewide research, quality improvement, and evidence-based practice projects. The inaugural project was designed to investigate and describe the practice of respiratory therapy in Pennsylvania. METHODS: A survey related to the practice and business of in-patient respiratory therapy departments was developed and sent to managers/directors of every hospital within the state of Pennsylvania. The survey period was October 2017 to April 2018. Pennsylvania hospitals were contacted to ask the respiratory therapy manager/director to complete the electronic survey. One hundred eighty-eight hospitals with in-patient respiratory therapy departments were contacted; direct information for the respiratory therapy manager/director was obtained for 159 hospitals. RESULTS: Of the 159 hospitals sent the survey, 101 (63.5%) responded. Of the respondents, 52% were academic medical centers. For staff positions, 50% prefer a bachelor's degree, and 77.3% prefer the Registered Respiratory Therapist certification. However, managers are only able to hire preferred candidates 50% of the time. Clinical ladders are utilized in 29% of the responding institution, and protocols are utilized in 74% of hospitals, with the most common being ventilator (92%), bronchodilator (79%), airway clearance (56%), hyperinflation (41%), and disease-specific (23%). Respiratory therapists in 84% of the hospitals perform nontraditional procedures, with the most common being electrocardiography (35%), advanced procedures including intubation (20%), arterial line placement (14%), blind bronchoalveolar lavage (14%), and electroencephalography (12%). Respiratory therapists are utilized in alternative roles in 42% of hospitals. The most common alternative roles are patient educator (29%), outpatient clinics (21%), patient navigators (19%), transport (14%), extracorporeal membrane oxygenation (6%), case managers (5%), research (5%), and telehealth (2%). CONCLUSIONS: The practice of respiratory therapy in the state of Pennsylvania varies greatly, with a small number of hospitals practicing at the top of their license.

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BACKGROUND: Staffing strategies used to meet the needs of respiratory care departments during the COVID-19 pandemic included the deployment of respiratory therapist extenders. The purpose of this study was to evaluate respiratory therapist extenders' comfort level with critical care ventilators while caring for patients with COVID-19. To our knowledge, this is the first study to evaluate the deployment of certified registered nurse anesthetists (CRNAs) in a critical care setting. METHODS: A qualitative survey method was used to assess CRNA experience with critical care ventilators. Prior to deployment in the ICU, CRNAs were trained by clinical lead respiratory therapists. Education included respiratory clinical practices and ventilator management. Sixtyminute sessions were held with demonstration stations set up in ICUs for hands-on experience. RESULTS: Fifty-six CRNAs responded to our survey (63%). A mean 6 SD of 9.48 6 12.27 h was spent training prior to deployment in the ICU. CRNAs were at the bedside a mean 6 SD of 73.0 6 40.6 h during the pandemic. While CRNA comfort level with critical care ventilators increased significantly (P < .001) from the beginning to the end of their work experience, no statistically significant differences were found between CRNA comfort based on years of experience. Differences in comfort level were not found after training (chi-squared test 23.82, P 5 .09) or after ICU experience was completed (chi-squared test 5 15.99, P 5 .45). Similarly, mean comfort level did not increase based on the number of hours spent working in the ICU (chi-squared test 5 13.67, P 5 .55). CONCLUSIONS: Comfort level with mechanical ventilation increased for CRNAs working alongside respiratory therapists during the COVID-19 pandemic.

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