As a team, we have faced very difficult challenges with patients who required end of life care, and very happy times when we have helped patients to recover from being on ventilation or CPAP, to being discharged home from hospital.
My name is Karen Brewin, I am the clinical lead for critical care and respiratory medicine and my team also looks after patients in surgery, cardiology and our emergency department at our emergency care hospital in Cramlington. As well as helping to look after patients who are staying in hospital, we also see patients who aren’t and who are referred to us for pulmonary rehabilitation, breathing pattern disorders, asthma, bronchiectasis, interstitial lung disease, lung cancer, cardiac rehabilitation and long Covid-19 clinics.
The main role of a respiratory physiotherapist is to help patients to breathe better, by clearing secretions from the lungs, increasing lung volume and reducing the amount of effort needed to breathe.
This is achieved in a variety of ways including education and teaching patients to do different breathing techniques. If patients are unable to do effective techniques by themselves, then we may help them to achieve the same effect with equipment for example to help a patient to take a bigger breath than they can manage on their own.
We see patients who are extremely sick and who may be ventilated and sedated on critical care, to patients who are well enough to be discharged from hospital. We help patients to wean off ventilation and improve their ability to walk, do daily activities and progress their ability to exercise. For patients in respiratory failure, we run a successful physiotherapy led NIV (non-invasive ventilation) and CPAP (continuous positive airway pressure) service on the respiratory support unit and this service operates 24 hours a day, 365 days a year. The model and outcomes for our NIV service has been presented nationally as an example for others services to see, and we provide annual training to our staff delivering this service to ensure it remains of very good quality and up to date.
Over the past year, our attention has been focused on the Covid-19 pandemic. We have been on the frontline in critical care, the respiratory support unit and on other wards treating many patients who were Covid-positive with oxygen therapy, proning and CPAP. Proning is helping patients to lie on their front to improve how much oxygen the patients can get into their lungs.
Many patients with Covid-19 have spent prolonged stays on critical care and the respiratory support unit, requiring a lot of physiotherapy treatment time per patient per day, and it has been really important to have amazing teamwork in order to provide the best care for these patients.
We have worked closely with the doctors, nurses, pharmacists and dietitians to provide the right care for patients whilst on ventilation or CPAP. We have also worked closely with medical engineering, procurement and the supplies teams in order to have the equipment that we needed to provide the right care. We have also been supported by domestic staff who have cleaned the rooms so that we could move patients into the right place to have the treatment they needed as quickly as possible.
As a team, we have faced very difficult challenges with patients who required end of life care, and very happy times when we have helped patients to recover from being on ventilation or CPAP, to being discharged home from hospital. We are now part of the post-Covid-19 multi-disciplinary team clinic seeing our patients who have been critically ill following their discharge from hospital and those suffering with respiratory symptoms from long-Covid.
It has been an incredibly challenging year, one in which we had many new things to learn very quickly. Our clinical practice has had to adapt so that we can treat a new illness, but we now have hope with the roll out of the vaccination.
We look forward this year to seeing more of our outpatient caseload again (patients who don’t need to stay in hospital), and welcoming our patients with chronic obstructive pulmonary disease (COPD) back to pulmonary rehabilitation. This service is so important because it reduces hospital admissions and improves functional ability, breathlessness and quality of life for people in the community.