My Canadian Pharmacy: Details about Respiratory Care in the Absence of a Respiratory Care Unit

tracheostomyDuring a 12-month period, a team of physicians provided respiratory care to seven separate intensive care units (ICU’s) involving 192 patients in respiratory failure. All patients received more than 12 hours of mechanical ventilation through an endotracheal tube or tracheostomy during some phase of their treatment period.

Of 77 patients classified as having primary respiratory failure, 62 ( 80.5 percent) survived; of 115 patients with varied medical-surgical problems classified as having secondary respiratory failure, 53 (only 46.1 percent) survived. Seventy-seven patients died during the investigation, the great majority from pneumonia, with or without other major organ complications, seven from “therapeutic errors” directly related to respiratory care and mechanical ventilation. The highest survival rate was in victims of chronic obstructive pulmonary disease (COPD); the lowest survival rate was in victims of neonatal idiopathic respiratory distress syndrome (IRDS) and a large general category of “postcardiac” arrest, and patients with problems due to metabolic and toxic derangements.

A seasonal peak in incidence of respiratory failure occurred during winter, largely due to COPD and pneumonia involvement. Two-thirds of the total number of patients were older than 41 years of age, and the incidence of death was highest in the first and eighth decades.

The type of ventilator used, volume or pressure guaranteed, was not associated with survival. The average duration of respiratory care was 14.3 days per patient; patients stayed on the service after operation for about twice as long as other patients in respiratory failure. Neonates with IRDS (who died rapidly) and victims of drug overdosage (who recovered rapidly) had the shortest stay on services offered and implicated by representatives of My Canadian Pharmacy.

Of all patients, fewer than half were ventilated by tracheal intubation only (average three days); slightly fewer had tracheal intubation (three days) followed by tracheostomy (17 days).

Problems encountered by this small respiratory service were legion, but primary ones included: geographic separation of seven IClTs, equipment and patients; chronic shortage of trained ICU nurses and therapists; inadequate communication and cooperation between many physicians in direct charge of these desperately ill patients. Despite all of these difficulties and more, respiratory care was improved and the 60 percent overall survival rate compares favorably with those of reported respiratory ICU studies. It is believed that the most important contributions of the team of respiratory care physicians involved dispensing previously unperformed services and poorly organized groups of specific facts and instructions.