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Point-of-care ultrasound is a useful tool in patient assessment that can help with many situations, leading to early interventions as well. This can be especially important when the patient is in one of Canada’s remote Arctic communities of Nunavut, thousands of kilometers from a tertiary care centre with a trauma ER or an operating room. POC ultrasound has been found to be a useful tool in these situations, providing quick diagnostics and interventions prior to or during long flights south to receiving facilities, and RRTs have been at the forefront of its use. This presentation will discuss the RRT’s role in ultrasound use in the transport environment of Canada’s Arctic, exploring the differential diagnoses determined through scans, and what interventions may be done by the RRT and transport team. Case studies from the presenter’s and colleagues’ experiences will be explored and discussed as well, revealing how the RRT profession is constantly adapting and improving patient care even in such a unique environment., Background Ongoing critical care interventions such as ventilation are not meant to be delivered in rural sites, however proximity to urban centers, transport team availability, and inclement weather often force some rural sites to manage critically ill clients despite approving a transition to another center. There is a province wide initiative to manage patients as close to home as possible. Objectives: To explore an RRT-led initiative to safely and appropriately provide short term invasive and non-invasive ventilation interventions in rural EDs. To understand a risk based approach to rural ventilation. To understand the role of virtual support model in rural ventilation. Methods A collaborative model was used to: 1. incorporate clinical education and simulation training 2. develop a risk assessment matrix 3. Utilize virtual health technology for enhanced technical support Results Preliminary evaluation results will be shared Discussion Ongoing evaluation targets include assessing the nature of the virtual health calls, and the ventilation strategies used by sites engaged in the project Conclusion Based on the strength of respiratory practice leadership it is possible to provide early ventilatory interventions in rural sites when a unique approach to risk assessment, training, and immediate consultation is used., The Stroke and Geriatric Empowerment (SAGE) Unit is an assessment and short stay rehabilitation program designed for adults and is very successful in improving physical function and independence for clients admitted into the program. Accumulated evidences are in support of rehabilitation of stroke patients in an organized stroke unit. Clients who benefit from this program include individuals who are experiencing frequent falls, have had a recent onset of cognitive impairment and decline in daily functioning, require further rehabilitation from surgery, amputation or illness and lastly have had a stroke or suffer from neurological diseases. Most of these clients already have an underlying respiratory disorder such as COPD, atelectasis, and sleep-disordered breathing. Respiratory disorders are an important comorbidity in stroke that may increase mortality, the risk of recurrent stroke and other vascular diseases, worsen cognition and functional outcome, negatively impact the quality of life, and prolong hospitalizations. Registered Respiratory Therapists (RRTs) have an integral role in the assessment and the implementation of interventions for the patient with stroke who also has respiratory disorders or is at risk of respiratory diseases. Representation of RRTs in our experience on the SAGE program team was less than ideal. Availability of more RRTs time could enhance the elements of stroke rehabilitation and optimize the functional outcomes for stroke patients., The diaphragm is the main inspiratory muscle; therefore, its function remains vital to ensure adequate ventilation. However, respiratory disease, mechanical ventilation, and neuromuscular disorders can all impact normal diaphragm strength and function, leading to suboptimal breathing parameters. Inspiratory muscle training involves providing a resistance to inspiration, applying the principle of strength training to the diaphragm and inspiratory muscles. Early studies of IMT appeared in the late 1970’s and since then there has been a plethora of research investigating the effect of IMT in various populations including: COPD, neuromuscular disease, mechanical ventilated patients and even in healthy athletes. This presentation will briefly review the most recent evidence on the use of IMT within respiratory-impacted populations, highlighting both positive and negative results to allow participants to decide whether this is a tool that would be useful in their own clinical population., When a pandemic hits, impacting the respiratory care and RT practice, the need for a team of experts to fluidly and nimbly make decisions and lead practice changes across the hospital to: 1) keep patients cared for; and 2) keep staff safe, is paramount. At Michael Garron Hospital in Toronto, the rapidly changing COVID-19 pandemic requires significant leadership in the area of respiratory care. The implementation of the Respiratory Care Committee (RCC) is the hospital’s solution. The committee representation ranges from senior executive and command centre leaders, to infection prevention and control, clinical practice leaders, ICU/ED/RT leadership, physicians and front line staff RTs. The committee is granted the authority, by the hospital executive, to make all relevant consultations, inquiries, decisions and dictate changes for the respiratory care of patients across the hospital. This is enabled by weekly surveillance, planning, practice change alerts and significant practice changes and equipment needed to support changes in practice. Acute attention is needed in the areas of: critical care capacity and expansion; ventilator procurement; management of aerosol generating medical procedures; alternative structures for delivering care in negative pressure environments and significant health human resources expansion and redeployment. The RCC is responsible for informing the ethics committee on balancing the polarity between safe respiratory care practice with the needs of the patients and in some cases the need to palliate versus treat based on the evolving situation. The need to make frequent and rapid changes dictates the need for significant support from the clinical practice leadership (RT, RN, MD) with emphasis on the elements of high performing teams: 1. strong communication; 2. role clarity; 3. conflict management; and 4. collaborative leadership. Ensuring staff have the most up to date practice changes and rules of the road as the high risk providers (RT, MD, RNs) is a key component of the success of these changes. The RCC remains a standing committee within the hospital structure to ensure clinical respiratory practice is of the highest quality, standardized, recent and relevant, evidenced based and both nimble and responsive to internal and external influences. This is regarded as a valuable and now irreplaceable hospital structure for leading the delivery of high quality, safe respiratory care., The practice of mechanical ventilation has never been pushed so far into the spotlight as it has during the COVID-19 pandemic. Both experienced and non-experienced healthcare providers wanted to learn more about how patients with severe COVID-19 infection could be effectively managed. This lecture will describe some of the many controversies, and growing interests that have arisen during the pandemic and describe the role of the respiratory therapist in providing the best possible care., On March 11, 2020, the World Health Organization declared the novel coronavirus (COVID-19) outbreak a global pandemic. For most, this meant a heightened state of awareness, fear of the unknown and a whole spectrum of other emotions. For us, as respiratory therapists it also meant a call to action and capitalization on knowledge, skills and a career worth of preparedness. To help healthcare professionals in the global pandemic fight, many organizations initiated projects involving the use of crowdsourcing to solve problems associated with COVID-19, from developing therapies and diagnostic tests to manufacturing protective equipment and ventilators. On March 18, the Montreal General Hospital Foundation, in collaboration with the Research Institute of the McGill University Health Centre , launched a global innovation challenge, Code- Life-Ventilator-Challenge, calling for teams to design a simple, low-cost, easy-to-manufacture and easy-to-maintain ventilator which could be deployed anywhere needed to save lives. To say that building a low-cost, simple, easy to use and easy to build ventilator is a challenge, is probably the understatement of the year. On March 20, we assembled the Fanshawe-Toyota team and entered the competition with four engineers and two respiratory therapists, venturing into this unknown world to give our best effort to a seemingly impossible task to design and build the COVINATOR FT. Out of more than 900 participating teams with over 2500 participants from about 90 countries in the first phase of the competition, our team’s design was selected along with only eight other teams to compete in the semifinals. This next phase involved improvements to the prototype and preparing of manufacturing packages as well as presenting the project. The tragedy of this pandemic has taught us many lessons including the importance of working together and thinking outside the box for innovations in order to turn challenges into opportunities. We would like the opportunity to present the journey of building the COVINATOR FT to our fellow respiratory therapist with the hope to spark interest in innovation and to demonstrate the importance of RT input in building equipment they use. We will use our prototype at Fanshawe College for teaching purposes to inspire innovation and encourage students to think outside the box, collaborate in multi-disciplinary teams and every once in a while try to do the impossible., The world watched in shock as Italy ran out of ICU space and ventilators with the COVID-19 pandemic in the early part of 2020, and collectively gasped as New York came close to repeating the nightmare. Every ventilator on the shelf was quickly claimed, and desperate calls for more were heard. A multitude of engineering teams quickly assembled and attempted to answer that call, and Health Regulatory Agencies such as Health Canada scrambled to find a way to regulate and approve these devices to prevent an Italian-type shortage on their home turf. Several devices emerged from this process, and to varying degrees they approached what could be considered a mechanical ventilator. Now that we are facing a potential second wave of the pandemic and a potential renewed pressure on our health care system, what new ventilators have emerged, and how do they compare to our standard ICU ventilators? Can a quickly-assembled team that has no experience with ventilators make a device that is safe and effective to use? If these were the only ventilators available, could they and should they be used in a situation that has stretched the health care system beyond its breaking point? This talk will review the ventilators that have emerged on the North American scene. They will be grouped by modes and monitored parameters to form a landscape of capability. A deeper dive will be undertaken to discuss the size of the gap between pandemic ventilators and standard ICU ventilators, and potential risks and shortcomings will be explored. Finally, the talk will wade into the murky waters of professional and ethical considerations of using these devices on patients and explore ways to improve the risk profile of using them., In the early months of 2020, when the COVID-19 infection and hospitalization rates began to climb in Canada, all resources were brought to bear to avoid medical crises described in Italy and New York that lead to our now global pandemic. With the global supply chains at risk, Health Canada led the way, with the Minister of Health approving an interim order to speed up the review of medical devices. Alberta Health Services’ (AHS) approach for meeting worst-case ventilation needs when the rest of the world was doing the same was to search for global solutions in distant locations such as China and assist local engineering groups with device design and navigation of the approval process. The presentation will review the experiences of a small, RT-led group of experts that managed the project. Patty Wickson, RRT, led the group, and will describe the scope of the project and how she was able to find the other members of the group and work with them to formulate a master plan and build an Alberta Pandemic Ventilator collaborative. The effort started with understanding the landscape of available ventilators and finding candidates that were both suitable and available. The second arm of the project focused on assisting Canadian-centered companies, most with minimal levels of medical device experience, with their ventilator designs by providing a direct line to AHS ventilation and regulatory experts. The collaborative group met regularly on-line with all stakeholders present to share experiences with Health Canada and facilitate beneficial connections in the regulatory, manufacturing, and medical device production space. Mark Rimkus, RRT, will present on the development and execution of a plan to test the interim order ventilators and to determine their safety and effectiveness at ventilating COVID patients. The specific approach to understanding the gaps between long-standing ICU ventilators and new-to-market designs will be discussed, as will the risk-analysis approach to understanding potential issues with deploying them on patients. The presentation will conclude with a discussion of lessons learned, future opportunities realized, and how a wider collaboration across provinces would greatly improve the process with other items such as PPE. The AHS team stills collaborates with ventilator designers and manufactures as well as supporting linkages to export their ventilators to other parts of the world. An exciting example to share with the RT community!, Introduction Burnout Syndrome (BOS) has been described as a modern day healthcare crisis. In 2017, the Maslach Burnout Inventory survey was conducted among healthcare practitioners at a critical care department in a tertiary care facility. Physicians, nurses and respiratory therapists were surveyed. All professions demonstrated evidence of moderate to high levels of Burnout, however the RTs displayed the highest levels of Emotional Exhaustion and low Professional Accomplishment among the participants. This paper will describe a qualitative thematic analysis into the root causes of BOS among the respiratory therapists working at this heath care facility. Methodology Focus groups of doctors, nurses and RTs were facilitated in February 2018. Eight respiratory therapists participated, representing 15% of the larger department of therapists. The 90-min focus group was facilitated by a trained qualitative researcher and was recorded and transcribed for accuracy. Transcripts were coded for themes and tracked using the qualitative data software Quirkos™. Results Themes that emerged from focus group discussions highlighted some of the milieu and organizational aspects that contribute to burnout for this respiratory therapy group. Some themes were unique to the respiratory therapist’s experience in the ICU while others were common among all health practitioners examined. The themes included Organizational Issues, Poor Team Dynamics and Exposure to High Intensity Situations. Conclusion The respiratory therapists at this tertiary care facility demonstrated moderate and high levels of BOS, particularly within the domains of emotional exhaustion and lack of professional accomplishment. The themes that emerged from their focus group session included Organizational Issues, Poor Team Dynamics and Exposure to High Intensity Situations. Respiratory therapists at this organization experience a lack of resources, particularly on night shifts. The pressure of being the educated and the educator in a fast paced ICU is also seen as contributing factor to burnout among this RT team. The role of the RT in end-of-life care ports some moral distress as futile care is both a perceived and real component of ICU care. The lack of recognition and appreciation for the knowledge, skill and resource challenges of the RTs was highlighted as an issue that feeds into poor team dynamics within the ICU, particularly between the nurses and the RTs., Since the 1980s, laws, regulations and medical knowledge permits and accepts that treatment can be withdrawn to let nature take its course at the end of life. One of the technologies that can be withdrawn is the ventilator, more commonly known as the respirator or life support. Who is responsible to remove or withdraw the ventilator at the end of life? How is this legitimized as being a moral action? Much research has been done to explain the difficulties encountered by healthcare professionals and families. However, one actor is most of the time neglected or completely absent from research; the respiratory therapist. In ICU, ventilators are closely monitored and managed by respiratory therapists. For ventilatory support, doctors are responsible to write the orders, but it is the respiratory therapists that do the action of removing the technology. In this presentation, I will discuss the preliminary results of semi-structured interview (n:20) done with respiratory therapists in Canada about their perception of doing terminal extubation., This presentation will review preliminary results of a Canadian national study conducted by St. Joseph’s Healthcare Hamilton and McMaster University. The aim of this project was to examine mental health and moral injury in RRTs in Canada. Recent research suggests that Ontario Respiratory Therapists’ and students’ risk for occupation-related PTSD is comparable to that of Paramedics (Foster et al. 2020). Despite these high rates, RT’s are often overlooked for debriefings and other psychological supports and resources, potentially placing them at increased risk of PTSD. Throughout the COVID-19 pandemic, the profession encountered an added layer of incredibly stressful and complex situations. The goal of this presentation is to increase awareness of the importance of addressing Mental Wellness of therapists and students., As healthcare systems and delivery evolves, novice leaders need to adapt to the increasing complexity and are at risk for burnout. Resilience is the process of adapting positively when faced with adversity. Resilience is not just a characteristic but a skill that can be developed. Furthermore, resilience is more than just a characteristic of effective leaders and high functioning teams, it’s a skill and quality that leaders can develop and then foster in their teams. It’s important for novice leaders to recognize signs of burnout and factors that will impact resilience. This presentation will discuss the key features of resiliency and burnout from the perspective of a novice leader navigating the unique challenges of the COVID-19 pandemic as well as the expected challenges and new opportunities encountered along the path of professional growth and development as well as strategies that can be used to promote resilience., Human factor is an established scientific discipline that studies the interrelationship between humans, equipment and the work environment. Core aspects of human factors include three dimensions: cognitive, interpersonal and personal resources. This area of study was first used in the aviation industry 40 years ago after studies suggested deficiencies in this field may have been significant in fatal accidents. The evolving use of this science and its emphasis on safety has directly influenced our current approach to anesthesia, critical care and healthcare in general. The main objective of human factor “science” is to optimize the interaction of humans with their work environment and technical equipment in order to maximize patient safety and efficiency of care. The core aspects mentioned above will be explained and elaborated on during the presentation through definition, examples and case studies. The complexity of the relationship between human behavior and technology, tasks, the environment and organization will be addressed. Human factor frameworks have been successfully applied to aid with these considerations thus providing a better understanding of the healthcare system and increased patient safety focus. In summary, a human factors approach is not yet mature in healthcare but its importance is increasingly recognized and its applications are being continually expanded., This presentation describes the irony of someone who spent nearly 30 years in the respiratory equipment business developing pulmonary fibrosis and ultimately receiving a double lung transplant in Toronto. The presentation covers the timeline from diagnosis to years of management prior to transplant and ultimately recovery. The roles of RT through the entire process are detailed. Awareness of pulmonary fibrosis and organ donation are highlighted., Canada is blessed with a diverse population and prides itself on welcoming people and cultures from around the world. The healthcare workforce should be representative of this diversity, in order to best serve and reflect the needs of our population. This presentation provides a synthesis of the emerging literature around the experiences and challenges of visible minorities, immigrants and people of colour in entering programs in health education, and the factors that can hinder their success in those programs. Structural, social and economic challenges are identified, and methods to address these challenges are explored. Respiratory therapy graduates who equitably represent our population, and are academically, clinically and culturally competent, will be well positioned to serve our diverse patients, and advance the profession and practice of respiratory therapy., Introduction and literature review Currently, there is a gap in knowledge for pediatric mechanical ventilation (MV) management. Limited data exists on this topic as there are considerable ethical liabilities when performing clinical trials on children. Limited research suggests protocols reduce adverse events and improve clinical outcomes. Inconsistent MV practices and the lack of data in children make it difficult to determine the best practices. Protocols are available but vary across centers with minimal compliance. Thus, reducing variations in MV techniques may improve safety, efficiency and clinical outcomes. The European Society of Pediatric and Neonatal Intensive Care (ESPNIC) consisting of physicians, is the first group to establish consensus recommendations on many aspects of pediatric MV management. In Canada, respiratory therapists (RRT) have a large responsibility in MV management, so it would be of interest to see if they agree with ESPNIC. Objectives To develop pediatric MV consensus recommendations from the perspectives of Canadian RRTs. To compare Canadian RRT perspectives to the European Society of Pediatric and Neonatal Intensive Care Methods A Delphi Survey technique was utilized to gather Canadian RRTs’ consensus on various topics of pediatric MV management. The survey contents were based on the ESPNIC recommendations. A pilot Round was done prior to Round (R) 1 to finalize the survey contents with 53 statements. For R1, demographic information was collected, and participants reviewed and provided their clinical expertise for each statement in the survey. For R2 and R3, participants ranked their level of agreement or disagreement for each statement using a 5-point Likert scale and provided written feedback for statements they disagreed with. Post-study, summaries of the Delphi study were distributed to participants for final review and additional feedback. Results A total of n=56 participants from 15 different facilities in Canada consented into the study. In R1, 43 participants responded, of which 41 completed and two partially completed R1. The open-text feedback was reviewed and revised into 58 statements for R2. In R2, 51 participants completed the survey; three out of the 58 statements did not receive consensus (≤75%). Based on the written feedback and level of consensus, 10 statements were revised, and one additional statement were included for R3. Forty-nine participants completed R3 and all 11 revised statements received consensus. A total of 59 recommendations on commonly RRT-practiced pediatric MV techniques reached consensus after three Rounds. Conclusion To date, this is the only Canadian pediatric MV management consensus guideline for critically ill children. This guideline contains 59 recommendations, organized into 10 subsections: 1) Noninvasive ventilation, 2) Tidal volumes and inspiratory pressures, 3) Respiratory rate and inspiratory time, 4) PEEP and Fio2, 5) Advanced modes of ventilation, 6) Weaning, 7) Physiological targets, 8) Monitoring, 9) General MV, and 10) Equipment adjuncts recommendations. This guideline can serve as a foundational document at different Canadian pediatric critical care units to help standardize pediatric MV practices for future studies., The Respiratory Therapy Practice-Based Outcomes Initiative (RT-PBOI) was implemented to explore, measure, evaluate, articulate and foster the value that respiratory therapists contribute to the provision of evidence-informed respiratory care. Alberta Health Service, CSRT, and the College and Association of Respiratory Therapists of Alberta are collaboratively seeking to examine the value that respiratory therapists contribute to health care teams and patient outcomes in the provision of respiratory care. The RT-PBOI team is prepared to share preliminary findings of their first knowledge translation activity designed to put evidence into action and positively impact patient outcomes and improve administrative decisions., In our new and ever-changing world, due to the pandemic, researchers and healthcare providers are looking into ways to combat COVID-19 either through prevention or treatment. Covid-19 can develop into pneumonia or Acute Respiratory Distress Syndrome (ARDS) and present with mild to severe hypoxemia. This can lead to respiratory distress or respiratory failure, often progressing to intubation with an increased risk of mortality. In patients with ARDS, proning is used to increase oxygenation and improve mortality. Many forms of therapy can be used to treat hypoxemia such as high flow nasal cannula or Optiflow. These forms of treatment can be considered an aerosolized generated medical procedure and may be insufficient to correct ventilation/perfusion (VQ) mismatch. Early proning on awake, non intubated patients was researched as early as 2003 but has gained momentum since the pandemic became widespread. Using prone positioning on spontaneously breathing non-intubated patients can treat the effects of hypoxemia, correct VQ mismatch, and improve dyspnea. This presentation will investigate how proning spontaneously breathing, non-intubated patients affect oxygenation and gas exchange by correcting hypoxemia, VQ mismatch and shunting. Additionally, studies will be reviewed that investigated oxygenation as well as effectiveness in preventing intubation. Limitations include such things as lacking case studies, small sample size, patient tolerance for length of proning, and the continued potential of intubation for some. More research is needed to investigate how to improve oxygenation in COVID 19 patients. Better standardization including control groups may be required to further understand how to treat the refractory hypoxemia response of COVID-19., Viruses. For almost a year now, these lifeless microbes, or one in particular, have been cited on television and radio news daily, the topic of many conversations between friends and family, and the culprit of many changes to our society in the interest of public health. Thoughts about the topic are likely bleak, however, shifting focus to the more amicable members of the family, the bacteriophage is introduced. With anti-microbial resistance on the rise, these bacteria-devouring viruses have been explored as synergistic or alternative agents to antibiotic drug therapy. The exceptionally stubborn multidrug resistant pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa, have presented a challenge across healthcare settings. Phage therapy offers a potential solution as effectiveness of antibiotic therapy is diminished., In recent years, equipment used to educate Respiratory Therapy students, has continued to evolve in the interest of better learning. These improvements offer students more realistic simulated experiences to prepare them for the clinical environment. The test lung is one piece of equipment that has seen little modification despite profound advancements in mechanical ventilation. Many modern ventilators have tools available allowing clinicians to assess and identify optimal positive end-expiratory pressure (PEEP) levels for patients. When using a traditional test lung, this function cannot be adequately illustrated for the learner. This was the initial reason for developing a more intricate test lung which allows the user to adjust pleural pressures surrounding the lung. By manipulating pleural pressure around the test lung, students may determine ideal PEEP using modern ventilator functions. Additionally, by encasing the test lung and creating a simulated pleural space, students can also attach a chest tube drainage system allowing for a deeper understanding of tidaling and potentially bubbling when appropriately attached to the test lung. Lastly, this test lung was developed to allow students to appropriately set patient triggers on a ventilator while the lung to trigger its own breaths. The development of this more advanced test lung can be used to afford students a more realistic experience using a ventilator in the educational environment., Introduction The COVID-19 pandemic has been an unprecedented threat to our health care system. Clinicians had to pivot and develop creative and timely “virtual” solutions to provide clinical care. Our aim was to develop a standard approach to virtual “mask fitting” for children who are either being initiated or already on existing longterm ventilation (LTV) at a pediatric hospital. Case and outcomes We present four cases involving the care of children who required mask fitting for non-invasive bilevel LTV (bilevel) in a single-centre experience. LTV team consultations were delivered via a telemedicine platform (online or phone). With the guidance of respiratory therapists (RTs) caregivers took measurements on their child using a standard clinical protocol for nasal and/or full-face masks. Based on the measurements, an appropriate mask was selected. RTs followed up with patients and caregivers regarding mask fit, and feedback on the process was collected. Discussion Virtual clinics used for managing patients in our LTV program were feasible and efficient resulting in improved workflow for the RTs and convenience for patients and caregivers. Patients and caregivers had significantly less pressure to attend in-person clinic and expressed high satisfaction in terms of their experience and importantly, meeting respiratory care needs. Within the context of COVID-19, remote patient education and intervention can be delivered effectively, while reducing the risk of exposure from in-person visits to hospital. Conclusion A virtual/telemedicine program to manage pediatric patients requiring mask fitting for LTV is a feasible option during COVID-19., Background With the advent of COVID-19 diagnostic and laboratory assessments of chronic conditions were postponed and rescheduled. The goal was to reduce unnecessary exposure and potential contamination of health care workers (HCWs) and patients. During this time sleep laboratories were urged to cancel or defer all scheduled in-laboratory or home sleep studies, as well as follow-up examinations of patients who have been previously receiving any form of sleep treatment. The possibility of cross-infection and the risk of spreading the virus using the same device limits access to diagnosis, thus increasing already overwhelmed waiting lists. Although there have been several suggestions and recommendations, currently no definitive guidelines have solved this issue. The usage of home sleep apnea testing (HSAT) may play an even larger role in the future of diagnosis, although there continue to be challenges. A 2-pronged learning approach will be applied First, to present the current guidelines and recommendations, particularly focusing on level 3 and home testing. Teaching method a digital interactive quiz system called Kahoot to have the learner participate in the overview of the guidelines and recommendations. We will also explore how people are currently approaching the challenges. (Learning theory: gaming theory-based). Followed by a mind-mapping exercise to examine potential solutions and recommendations for future best practice. Several topics will be provided. Teaching method interactive guided discussion., The LIVE program is an intensive clinical management program delivered via an eHealth platform (aTouchAway™) developed as a solution to the significant health and safety risks that the home mechanically ventilated (HMV) population faced during the early days of the pandemic. Co-developed by patients, families and healthcare providers, the LIVE program overcomes barriers of distance and travel time by bringing the “Right People with the Right Expertise at the Right Time” virtually into the homes of individuals using HMV. This eHealth intervention was developed for a CIHR funded randomized controlled trial which enabled a rapid pivot to an early clinical roll-out. As a result, the intervention became available during COVID-19 across the province to support children and adults from several HMV programs through timely engagement with the Ontario Ventilator Equipment Pool. Our goal was to provide a ‘virtual safety net’ for our patients with the aim of improving quality of life, reducing family caregiver burden, and preventing unnecessary hospital admissions. The program rolled out a novel, multicomponent intervention which enables virtual home visits, customizable care plans, clinical workflows, completion of symptom profiles and tele-monitoring, as well as secure communication via messaging, audio and video calls for patients, families, and healthcare providers. The presentation will focus on the provincial roll-out and implementation of the LIVE program; discuss the components of the eHealth intervention and discuss how children and adults using HMV are an ideal population for virtual care during the pandemic due to their medical complexity and fragility necessitating the need to bring ventilator experts into the homes of HMV users., After years of tentative and incremental progress towards more patientfriendly models of care that leverage technology, the SARS-CoV-2 pandemic has been an unprecedented catalyst for accelerating uptake of digital healthcare technologies across medicine. Virtual care has been adopted in respiratory medicine as it has in other disciplines, and limitations in pulmonary function testing capacity have accelerated the adoption of home-based lung function monitoring technologies. However, this unique requirement to monitor lung function, particularly in asthma and COPD, presents a specific challenge to virtual chronic disease management in respiratory medicine. In this talk, we will discuss emerging strategies for virtual management of the respiratory patient, with a focus on airways diseases. This will include technologies for remote lung function monitoring and the role of mobile health apps, smart devices, and wearables for disease monitoring and rehabilitation. We will also address emerging provider- and patient-facing technology for optimizing care and enabling patient self-management both efficiently and virtually.

We are pleased to present a select number of abstracts from the proceedings of the CSRT Annual Education Conference. Held in Niagara Falls, Ontario, May 9–11, 2019, this conference included topics delivered by international, national and regional individuals with expertise in various areas of respiratory therapy practice. As evidenced by the following abstracts, the work of our colleagues in 2019 highlighted current research and practice innovations led by RTs. We have made every effort to include all abstracts accepted by the Program Committee before the publication deadline; however, please note that this collection does not represent the entire program (available at www.csrt.com). The editorial board looks forward to receiving manuscripts from this conference for consideration for publication in the Canadian Journal of Respiratory Therapy to continue building the body of knowledge specific to our profession. Please note these abstracts have not been peer reviewed., This presentation will detail the state of respiratory care in rural Canada, discussing access to services and practitioner availability. It will provide a comprehensive overview of rural health care in a broader context and focus on how those patterns extend to respiratory therapy. Chronic disease management and education across populations will be highlighted, as well as primary care experiences at the onset of cardiopulmonary symptoms. The presentation will construct a profile of the rural patient and disseminate how their medical needs differ from those of urban dwellers – exploring statistics, social histories, and health beliefs/ideologies. Reasons for access discrepancies will be explored, as well as current and potential solutions to make respiratory therapy more accessible in the rural setting., In preterm infants, the most common cause of respiratory failure is respiratory distress syndrome (RDS) caused by pulmonary surfactant deficiency. As the gestational age of the neonate decreases, the risk of RDS development increases. According to Sardesai et al., “sixty percent of infants born at less than 28 weeks gestation will develop RDS, with an incidence of thirty percent in infants born between 28- and 34-weeks gestation, and in less than five percent of infants born after 34 weeks.” The connection between RDS and pulmonary surfactant deficiency was first recognized in the 1950s and the use of exogenous surfactant has since been accepted as the front-line treatment for this condition and therefore has been extensively researched. Many studies have been done since the 1950s to determine the optimal type of surfactant, timing of surfactant treatment, as well as surfactant administration technique. This presentation aims to briefly review the role of pulmonary surfactant in healthy lungs, to discuss the different components of the use of exogenous pulmonary surfactant in RDS pathology, to review the current techniques, especially the intubation, surfactant and extubation (INSURE) method with its modified techniques and their therapeutic outcomes, as well as explore potential future techniques, such as aerosolized approaches. The purpose of this presentation is to review current research on exogenous pulmonary surfactant administration, including the current techniques with a focus on outcomes as well as discuss future recommendations and their feasibility., The major risk factor for Chronic Obstructive Pulmonary Disease (COPD) has long been considered smoking. However, smoking does not guarantee the development of COPD, and many non-smokers also suffer from COPD. Reasons for this have been poorly understood for many years, however research lead by Benjamin Smith at McGill University has recently identified a previously unknown risk factor for COPD. Using the chest CT scans from more than 3000 participants in the Multi-Ethnic Study of Atherosclerosis, Benjamin and his team found that variations in central airway morphology, found in 26% of the general population, can lead to an increased risk of COPD. They identified two main patterns of branching variations, the first being an accessory subsuperior airway, which was identified in 16% of participants. This variation was found to have a 40% greater chance of developing COPD among smokers and nonsmokers alike. This morphology was also found to have segment lengths 3.7% shorter than average throughout the entire lung. All lobes also demonstrated larger airspace and central airway bifurcations. The second variation, absence of the right-medial basal airway, was identified in 6% of the population, and was found to have a 55% greater chance of developing COPD among non-smokers, and that risk increased to 78% among smokers. In this morphology, the lumen of the airways were found to be significantly narrower. The remaining 3% of the population had other rare branching morphologies. As CT scans taken over a period of 10 years did not show a change in airway anatomy, Smith and team concluded that these variations in morphology were determined in-utero. Through familial aggregation, they determined the accessory subsuperior airway would be present at a rate of 46% if one sibling was found to have this morphology, and the absence of a right-medial basal airway would occur at a frequency of 31%, suggesting a pattern of genetic inheritance. Smith and team believe their findings may one day influence treatment of respiratory diseases through the tailoring of therapy to one’s airway morphology. While abstaining from smoking still remains the best way to prevent COPD, perhaps in the future this simple diagnostic tool will help patients better understand their likelihood of developing COPD. If a patient is aware they are among the 26% who are at a greater risk of developing this terrible disease, perhaps they will have more motivation to put down that cigarette., BACKGROUND Providing optimal nutrition for critically ill patients reduces complications and decreases mortality. Determining accurate energy expenditure of a patient earlier, during their ICU stay can prevent the patient from being under and overfed and can ultimately aid recovery. The concept of indirect calorimetry (IC) involves measuring oxygen consumption and carbon dioxide production to determine the energy used by patients. Due to lack of education, resources, cost, and lack of personnel, IC is underused in the clinical setting. OBJECTIVE The aim of this paper is to examine the current use and potential uses of indirect calorimetry, specifically in critically ill mechanically ventilated adult patients. This paper will also evaluate the benefits and limits to alternative methods used to determine energy expenditure, such as ventilator derived parameters and predictive equations. Finally, the potential role of respiratory therapists in IC will be examined, and the significance of meeting nutritional requirements in critically ill patients will be discussed. METHODS A systematic literature review was conducted to evaluate the methods of determining energy expenditure of mechanically ventilated patients in the ICU. Only studies on mechanically ventilated patients were included. Dates of articles used range from 2011 to 2017. All articles are peer-reviewed. The articles used in this paper are composed of literature reviews, randomly controlled trials, and retrospective observational study. Due to a majority of these studies being performed clinically and not in a research setting, clinical changes in patient status could have affected the results. RESULTS Indirect calorimetry as gold standard due to patient-specific measurement and treatment. Most authors found ventilator derived values remained suitable alternatives to IC, when compared to predictive equations. Predictive equations were shown to underestimate calculated resting energy expenditure and result in underfed patients. CONCLUSION Modern technology has made indirect calorimeters more convenient and easier to use at the bedside. Increasing the use of IC by multidisciplinary teams, can lead to optimal nutrition for critically ill patients and can ultimately improve patient care., Research is considered an important part of modern evidence-based medicine. As a result, respiratory therapists (RTs) are expected to critically read articles, analyze scientific data, understand different research techniques, and even to be a part of the multidisciplinary research team. Usually, the RT curriculum provides students with some theoretical research knowledge such as critical reading. However, there is no clear pathway for RT students to obtain required practical research skills. Moreover, there is a consensus that early exposure of students to research activities is essential for all future health care professionals. For example, participation in research can help students to develop analytical skills which are important for clinicians in everyday practice. The question then arises how can RT students get practical research experience in an already overloaded RT program. Based on our experience, we propose a summer elective research observer-ship as a possible way to expose student RTs to research activities. Firstly, we will discuss the role of respiratory therapy research for improving patient care. The importance of research conducted by an RT as a unique specialist with deep knowledge in cardiovascular physiology and mechanical ventilation will be also shown. Secondly, we will review the reasons why research experience is important for RT students. The benefits not only for future possible research involvement but also for everyday clinical practice will be covered. Finally, both student and preceptor experiences of conducting a summer elective observer-ship in a mechanical ventilation research lab will be presented. The student and preceptor will discuss organization, structure and outcomes for this type of educational activity., Chronic Obstructive Pulmonary Disease (COPD) is projected to be the third leading cause of death globally by 2020. There is no cure for COPD, however, maintenance therapy has been shown to slow its progression and mitigate its symptoms. Symptom mitigation is, today, the only way for COPD patients to live comfortably with the disease. Mindful Meditation is a mechanism used to improve patient quality of life across many facets of healthcare, and this is particularly true for patients suffering from COPD. Research indicates that Mindfulness and other types of meditation may improve sleep patterns, decrease pain, control breathing, reduce anxiety and depression, and increase energy levels in patients with COPD. While the results of Mindfulness have been quite positive, further exploration of meditation-based techniques for COPD should be conducted. This will help to better quantify the benefits, as well as help determine the best application of the techniques moving forward., This presentation focuses on the incorporation of Tai Chi as an adjunct to standard care in patients with Chronic Obstructive Pulmonary Disease (COPD). The presentation will explore how Tai Chi is an accessible, effective, and low-risk therapy to those living with COPD all around Canada. The inspiration to further understanding of this topic was brought about while the presenter was working for The Lung Association and speaking to Alpha-1 and COPD patients to learn about their first-hand experiences with Tai Chi and how it has helped them manage their disease., Breathing Pattern Disorder (BPD) is a spectrum used to describe a group of breathing disorders where chronic changes in breathing pattern result in dyspnea and other physiological symptoms resultant of respiratory alkalosis. Additional terms used to describe BPD are hyperventilation syndrome and dysfunctional breathing. Both terms are used interchangeably in literature since a gold standard classification system is not yet available. Due to altered CO2 levels, a state of sympathetic dominance manifests with heightened fight or flight response. On the other hand, a chronic abnormal breathing pattern can itself be a symptom of another underlying respiratory pathology such as asthma or vocal cord dysfunction. In this case, the BPD is not considered dysfunctional breathing as there is a respiratory related root cause. Currently, there are no tests to clinically diagnose BPD. Hence, correlation between the variety of methods that are utilized to diagnose BPD are poor. The prevalence of BPD is hard to gather in the absence of gold standard test and mainly relies on exclusion of organic cause and a general method of assessment known as the Nijmegen Questionnaire. The following presentation will explore the general causes and effects of BPD, treatment options and their efficacies, and lastly examine its impact on motor skills, as well, learning process in children., BACKGROUND E-cigarettes (ECs) are battery-operated devices that vaporize a liquid containing nicotine, either vegetable glycerin or propylene glycol, and flavourings for inhalation without burning tobacco. ECs are currently the most popular method for consuming nicotine amongst youth and have often been marketed as a smoking cessation aid. However, research suggests “vaping” has additional negative impacts on the respiratory system, as well many individuals who initiate EC use have never once before smoked a cigarette. OBJECTIVE To evaluate the impact of ECs on the respiratory system and assess their role and efficacy in the community as a smoking cessation device. METHOD A systematic literature search of PubMed and Cochrane Library conducted between July and October 2018 for randomized control trials (RCTs) from the last 5 years that studied smoking cessation rates amongst ECs users were included, along with animal studies that evaluated ECs' effect on the lungs. Reference lists of selected studies were also reviewed for relevant information. Interviews of professionals in the field were conducted as well. RESULTS The chemicals inhaled from ECs caused an increase in oxidative stress and inflammation in mice when exposed to 18 mg/mL nicotine liquid for 1 hour/day for 4 months. EC users had a greater 6-month abstinence from cigarette smoking compared to those who used an NRT patch or a placebo EC. DISCUSSION ECs can cause users to develop an obstructive airway disease due to the nicotine content, however chemical exposure depends on several factors. Overall if used strategically, ECs can be an effective smoking cessation aid in users motivated to quit. CONCLUSION ECs may be an efficient smoking cessation aid, but the results vary with the individual. ECs can cause airway issues similar to those of traditional cigarettes, but more research is necessary in order to account for variables such as reliability of nicotine delivery as well as determine the long-term effects., Respiratory Therapy in Saskatoon is expanding and growing with current and upcoming employment opportunities within the Saskatchewan Health Authority. Saskatoon has three acute care hospitals a growing community presence and a brand-new children’s hospital, the Jim Pattison Children’s Hospital of Saskatchewan, opening in the fall of 2019. This session will highlight the respiratory therapy growth road map and discuss the innovations occurring within respiratory therapy in Saskatoon. This session will focus on the opportunities for employment and career growth for respiratory therapists in Saskatoon., Taking part in applied research at the college level is a brand new or foreign concept for many respiratory therapists. This session will look at our recent application to do applied research at our college. We will describe the process followed to apply for research funding from a national funding agency (NSERC and CIHR) as we required this grant funding to create a research project with the potential to become a permanent interprofessional community placement. We created this project to help solve the issues of the general lack of pulmonary rehabilitation available, a lack of community placements for our students, and to increase the student's awareness of the importance of self-management in chronic disease. As respiratory therapists, working full time as program instructors, it was challenging for us to create this opportunity for research and for knowledge sharing. We would like to share the challenges we experienced and use this opportunity for ideas and feedback with respect to this project., Will is 8 years old and is brought into the emergency department at the local hospital by his concerned parents. Despite providing Will with his rescue inhaler multiple times throughout the day, he continues to have chest tightness and cough. This scene occurs daily in Canada, as asthma is a leading cause of pediatric emergency department visits in Canada. This situation is certainly simulated in respiratory therapy education programs across the country, helping to prepare future respiratory therapists to care for children with an asthma exacerbation. This case is about caring for a child with asthma, and his family. A unique feature of Will’s family is that he has two dads. The case is not about diversity and inclusion; but it is. This presentation will discuss diversity and inclusion in respiratory therapy education in Canada. Highlighting simulation cases used currently in the presenter’s program, the presentation will discuss how building diversity into clinical cases can help provide a safer and more inclusive learning environment for all students, especially those from marginalized communities. Also, by representing diverse members of the community in clinical cases, students may be better prepared to care for patients and families from marginalized communities. Some of the marginalized communities included in clinical cases include Indigenous peoples, racial minorities, lower socioeconomic groups, LGBTQ2S+, and new Canadians. The professional practice of respiratory therapy in Canada is guided by the National Competency Framework (2016). In this framework, it clearly states that Respiratory Therapists must “carry out their professional tasks with respect for the rights and dignity of all individuals and without any form of discrimination.” Also, a Core Competency of all Respiratory Therapists in Canada should include “demonstrating empathy and respect towards patients and families” and “establishing partnerships with patients and families.” However, how often do respiratory therapy education programs include diverse and marginalized communities in their programming? An environmental scan will be conducted of respiratory therapy programs across Canada to share information on the extent of diversity and inclusion of marginalized communities in current programming. There will be time allotted at the end of the presentation for sharing of ideas and strategies to enhance diversity and inclusion in respiratory therapy education., As educators, we continually explore various teaching modalities to encourage students to become active participants in their learning. “Bringing the Classroom to the Community” is a project that is assigned to a respiratory course which is evaluated. This form of experiential learning empowers the student to participate in lung health education in the community. The educational goals of this project are twofold for the schools, as it promotes the necessity to students to be advocates for health promotion and it aligns with the requirements of the National Competency Framework core competencies. With modern information technology, a wealth of knowledge relating to health concerns is readily available to the public. However, there remains a need, or a preference, for personal interaction when seeking information about lung health issues especially with the most vulnerable population being the youth. Smoking education is prevalent in the community but with the increase of vaping and now with the legalization of cannabis, there is a greater need for health care providers to educate and empower the youth in taking control over their health. The qualitative data collected over 15 years from this project articulated the demand for the RRT students presenting to the community and the benefit to the RRT students in reinforcing how important community education is. Bringing the classroom to the community not only promotes collaboration and teamwork among students; it also provides an opportunity for students to provide resources to the community., Respiratory Therapy programs often receive far more applications than seats available. Due to the nature of this, there is a significant demand for any spots that may become available within the duration of the program. The majority of Respiratory Therapy programs across the country are a minimum of 3 years in length. As this is a significant period, situations arise that may require students to withdraw from their program. Some of these reasons are academic in nature while others may be due to medical issues, maternity leave, mental health issues or financial and accessibility reasons. When students fail to complete a program, given the opportunity, they may want to return later to complete their studies. Deciding whom the best candidates to occupy these valuable seats becomes a challenge. Many institutes across the country struggle with how to manage students who endeavor to return to their programs after they have been withdrawn. Where do these students fit? How do the institutes assess the maintenance of knowledge and skills for them to be successful moving forward? Has the student overcome the issues that had them withdraw in the first place? Are they the best candidate to occupy a sought-after seat? The Respiratory Therapy program at SAIT has developed a “Returning Student Policy” which lays out the expectations and requirements for students who have a desire to continue, and complete, their RT program experience. SAIT feels this clearly policy identifies challenges that students may have, as well as recognize the steps that students have taken to overcome whatever personal adversity caused them to withdraw in the first place. This presentation will share information with educators as to what has worked well for the SAIT Respiratory Therapy program in regard to returning students., INTRODUCTION The Lung Association and its provincial organizations across Canada lead and promote lung health, as well as the prevention and management of lung disease. Included are a number of lung health programs and initiatives that provide opportunities for leadership and citizenship for respiratory therapists and students. One such initiative is the Sleep Apnea Refurbishment Program which was developed at the Lung Association of Nova Scotia (LANS). Obstructive sleep apnea (OSA) is a chronic condition characterized by the periodic reduction or cessation of breathing during sleep causing recurrent arousal from sleep and hypoxemia. The health, social and economic consequences of unmanaged OSA are substantial. The gold-standard therapy for the management of OSA in adults is continuous positive airway pressure (CPAP). Those with OSA who have underlying lung disease or are unable to tolerate CPAP, are treated with bi-level positive airway pressure (BiPAP) therapy. Unfortunately, these devices are costly and can be unaffordable for those with low income or without private health insurance. The LANS manages a refurbishment program of pre-used CPAP and BiPAP machines donated to them or through the Lions Club. An opportunity existed for undergraduate respiratory therapy students to participate in the refurbishment process. PURPOSE To examine the importance of social responsibility to respiratory therapy education and practice by describing opportunities for student engagement in community organization initiatives related to respiratory health, and the impacts of a community collaboration on students, patients with a respiratory disorder and non-profit organizations. APPROACH Members of the non-profit organizations who participated in the gathering and distribution of pre-used CPAP or BiPAP machines, respiratory therapy students who contributed to machine refurbishment, and recipients of CPAP or BiPAP will be invited to complete a survey about the impact of this community collaboration on their lives. Data collected through survey and interview will be analyzed and shared. OUTCOMES Achievements, challenges and impacts will be measured using qualitative and quantitative approaches. CONCLUSION Community collaborations have the potential to positively impact the lives of people with chronic disease, the experiential learning of students, and the satisfaction of persons who serve non-profit community organizations., It has been well established that quality improvement initiatives in healthcare provide patients with safer and more efficient care. Releasing Time to Care (RT2C) is a quality improvement program that has been adopted by Vancouver Coastal Health upon learning of the success of the program in England where it was initially developed in 2007 by the National Health Service. The core areas of the program are: safety and reliability of care, patient experience and outcomes, value and efficiency, and team performance and staff well-being. The RT2C program supports multi-disciplinary front-line staff to lead change at the point of care by offering tools to develop valuable skills in quality improvement. It empowers staff to ask challenging questions about healthcare practice, collect and analyze data to inform decision making, and streamline the way they work. This presentation will showcase completed TBQI projects that have successfully implemented change within healthcare practice in order to provide more efficient patient care and enhancing staff well-being simultaneously. Gurprit and Jennifer will share the success of their team, a collaboration between a critical care RN and RRT, in establishing quality improvement measures within the intensive care unit at VGH successfully. They hope to demonstrate the importance of Respiratory Therapy representation in quality improvement movements and multidisciplinary collaboration in leadership initiatives., In today’s technological world, many hospitals are striving towards a fully integrated electronic patient chart. This presentation shares the journey of a Respiratory Therapy department through the transition from a mostly paper-based charting system to an almost fully electronic patient chart. The presentation will discuss the various challenges that the Respiratory Therapy department faced during the design, implementation and post-implementation management of the electronic medical record as well as the many benefits to having an electronic charting system in place. The presentation will end with the sharing of lessons learned and suggestions for consideration to any Respiratory Therapy department or leadership team that is about to embark on the design and implementation of an electronic medical record., Education is an integral part of the healthcare system and the respiratory therapy profession. Student respiratory therapists are a fixture within our hospitals and come to us to learn as much as they can from this rich clinical environment. While students gain valuable knowledge and experience during their clinical time, there is also an opportunity for them to educate us. By implementing learning outcomes and assignments meant to challenge students to look into best practice on topics integral to RT practice, students can actual foster policy change and challenge staff and departmental administrators to take a second look at the way we practice. This can even lead to tangible change in achieving up-to-date evidence-based practice. One assignment fostering this goal occurs during the first half of the 3rd year student’s clinical year. The students are tasked with a team project aimed at researching a new advancement or a debated topic within current practice. They must find best evidence and compare this research to what is actual done within the clinical site. We then ask them to consider why or why not practice matches evidence found in their research and we also ask them to come up with ways to ensure that best practice is followed or implemented. In previous years this project has provided a challenging learning experience for the students as well as a valuable learning opportunity for the RT staff and administration. The students present to their classmates, the CSC and their presentations are also open to staff and the leadership team. Through this assignment we are encouraging the next generation of respiratory therapists to be inquisitive and progressive in the ways they develop their practice. It also ensures that students and staff don’t become complacent in practice and continue to advance the profession together., The concept of a pain-free procedure for children has been part of the Children's Emergency departments for over 10 years and there is significant supporting this practice. There is evidence of this practice in the dental literature where they use 70/30 % mixture in children in short term procedures. One of the areas that the Respiratory Therapist are working with are the Spinal Muscular Atrophy (SMA) children and the current administering of Spinraza. The SMA children have a mutation in the SMN1 gene, this leads to a reduction of SMN protein. This protein will result in a loss of function of neuronal call and a progressive muscle wasting and mobility impairment. The Spinraza is a intrathecal injection which allows the Spinraza to reach the central nervous system. When we started the injection these children would have the procedure in the PICU. A hospital wide team worked to moved these patient to the Medical Day unit. May of these children are respiratory Compromised and on Noninvasive ventilator support. In working with BCCH and the Ministry of health how did we use the skills set of the Respiratory Therapist to provide safe pain free procedure. How did we incorporate the RT's into the planning of patient procedure, post recovery and assessment on needs for respiratory support at home., BACKGROUND Our healthcare environment is ever changing. In a centralized department, it can be challenging to keep up with changes to policies, procedures, guidelines, equipment, and workflow processes in all of the clinical programs and areas. In attempts to mitigate some of these challenges, a monthly education “blitz” program was developed, where education sessions of mixed teaching approaches are held on a weekly basis to support a monthly theme. OBJECTIVES The goal of monthly education blitzes is to provide staff with the opportunity to review current policies, procedures, guidelines related to the clinical programs that relate to the theme of the month. In consideration of adult learning theory, these sessions would individually consider the most appropriate teaching strategy to meet the objectives (i.e. hands-on, low technology simulation, didactic, interactive discussions, etc.). The monthly themes would continue annually, including updates to content. METHODS Broad topics were selected based on staff input. Focus group discussions and informal staff surveys generated a broad list of topics of interest and relevance to the staff. Further discussions with the leadership team resulted in narrowing and grouping the topics into nine monthly themes. These nine themes were then sub-divided into weekly categorized topics related back to the theme of the month. Experts from within the organization and consultation with experts in the field occurred to allow for variety to the facilitation. Recognizing that not all staff would be attending these sessions, they would be either 1) video recorded (with consent), or 2) presentations would be emailed out to the group. Either the video or the presentation would subsequently be uploaded to the staff desktop. Program evaluation to be completed utilizing the CIPP [1] evaluation framework. RESULTS Initial qualitative feedback gathered informally through small group discussions is seemingly positive. Engagement with facilitators has only proven to be challenging at times of busy clinical surge, otherwise also positive. Formal results from the program evaluation are pending at this time. DISCUSSION/CONCLUSION At this point, the general thought is that the monthly blitz strategy is a positive approach to delivering continuing education for a centralized department. Depending on the results of the formal evaluation, there may be further opportunity to look at this approach on a broader scale, to include program managed departments as well. There may also be inherent learning occurring within the facilitator group which will be determined with the utilization of the selected evaluation framework [1]., Respiratory Therapists face numerous stressors in their care-giving role that challenge the psychological capacity of “resilience.” To mitigate the negative impact of low resilience, developing and fostering resilience is emerging as a key to improving positive outcomes for individuals and the workplace environment. It is crucial that leaders be able to identify variables impacting resilience and be informed of evidence-based practices that may be utilized to foster resilience in the workplace. This session will provide leaders with insight into the key emotional intelligence competencies that contribute to resilience, discuss psychosocial and environmental variables that challenge resilience, and review current practices that have been demonstrated to promote resilience., INTRODUCTION It is estimated that Chronic Obstructive Pulmonary Disease (COPD) affects 2.6 million Canadians and is costing the healthcare system 1.5 billion annually. Funded by the Office of the Chief Health Innovation Strategist through a Health Technologies Fund, the Breathing Better at Home (BBH) initiative aims to relieve this economic and social burden. The BBH initiative is a single-center randomized controlled trial evaluating three different strategies (Standard Care [SC], Self-Monitoring [SM], Remote Monitoring [RM]) for the management of COPD. This initiative provides valuable insight into the feasibility of a technology enabled self-monitoring program. Evaluation of these management strategies in relation to Hospital Admissions (HA), Emergency Department (ED) visits, Length of Stay (LOS), and workload will provide a useful framework for the development of future chronic disease self-management programs. METHODS Enrollment of 122 patients, to be followed for 6 months, was completed in September 2018 with patients divided into three study arms. The SC arm is routinely followed by a respirologist in the COPD clinic. Patients in the SM and RM arms are given technology to monitor their vital signs and COPD symptoms as well as a comprehensive action plan that directs care. The RM arm is supervised by a Respiratory Therapist (RT) who contacts patients weekly. The SM arm is not monitored and there is no clinician-initiated contact. In the event of any clinical issues, patients in the RM and SM arms are encouraged to contact the RT during regular business hours and after hours their family doctor or ED. Validated tools including the St. George's Respiratory Questionnaire, the Bristol COPD Knowledge Questionnaire, Partners in Health Index, as well as self-reported ED visits, HA, and LOS are assessed at baseline, 3 and 6 months. CONCLUSION Independently, self-management and remote-monitoring solutions have been associated with lower ED rates and reduced HA. These solutions may not be sustainable or have limited potential for spread and scale. The BBH initiative will be completed March 2019 with preliminary data expected to be available in early 2019. It is anticipated that this data will support the hypothesis that a technology enabled self-monitoring program is both feasible and safe. This talk will describe the research methodology, current findings and future initiatives being considered at MSH for technology enabled self-management., The successful establishment of intravenous access (IV) can be difficult, especially during medical emergencies. During these times, securing IV access quickly and safely is vital for the rapid delivery of fluids and medications; and can ultimately be lifesaving. Intraosseous (IO) needle insertion is a reliable alternative when IVs are unattainable. Presently, the use of IOs as a bridge to vascular access during medical emergencies is best practice, in the current Advanced Cardiac Life Support algorithm, and should be the first method of choice when vascular access cannot be established by traditional means. Current literature suggests that there are universal barriers to IO use in a clinical setting, despite having obvious benefits. As IO insertions are an Advanced Practice for RTs, and with RTs being present at every medical emergency; the RT group presents as an excellent opportunity to integrate IOs into resuscitative practice. The consistency of their presence will provide added support to the advocacy of the skill when needed, support to clinicians, and expand RT skills to IO insertions. The purpose of this quality improvement (QI) project was to train 10 RTs that work clinically at the Princess Margaret Hospital site at UHN to be proficient in IO insertions, and to create an approved education package by the College of Respiratory Therapists of Ontario. A needs assessment was performed with the distribution of a clinician survey to assess current barriers to IOs in surrounding peer hospitals/units. A “train the trainer” session was completed, RTs trained, and interest for expanded education to nurses garnered. This further emphasizes the positive outcomes that expanding RT practice can have on skill, scope of practice and interprofessional relationships. An informal interview with RTs post training was used as a process measure to evaluate the training itself. A review of this project will highlight key concepts in QI such as identifying gaps, developing an idea, implementing change, and how to measure success. Discussion will provide insight on the impact of bridging the RT role from a clinical setting into the QI stream on RT practice, profession and improved patient care; and share experiences on getting started and lessons learned. As healthcare is ever evolving, the tandem progression of RT practice and proficiency in all realms of patient care (clinical and non-clinical) is crucial to maintaining excellence in both patient care and advocacy., PURPOSE Obese and pregnant patients admitted to the ICU are challenging to ventilate because of increased chest wall and abdominal pressures. This decreases lung compliance and exacerbates atelectasis, contributing to lung injury. While optimizing PEEP is one of the cornerstones of lung protective ventilation, the higher pressures needed in these patient populations creates a challenge for ventilation management. Esophageal pressure is demonstrated to be a good measure of pleural pressure and can be used to determine the amount of pressure directly transmitted to the alveoli. METHODS This is a retrospective case series of 18 obese and pregnant ICU patients. PEEP, driving pressure, P (A-a) O2 gradient and PaO2/FiO2 ratios on admission to the ICU were compared to those values after PEEP optimization using esophageal pressure manometry. RESULTS PEEP is significantly higher after esophageal pressure optimization (p = 0.000) with no resultant increase in driving pressures (p = 0.38), despite an increased plateau pressure. The PaO2/FiO2 ratio is significantly improved (p = 0.031). FiO2 is significantly reduced (p = 0.000) and there is a significant improvement in P(A-a) O2 gradient (p = 0.016). CONCLUSION Esophageal pressure guided PEEP optimization results in higher PEEP and plateau pressures, significantly improving oxygenation and intra-pulmonary shunt in obese and pregnant ICU patients without increasing driving pressure., There is an emerging need for knowledge that can inform practice in the profession of respiratory therapy. Not only will this knowledge serve to inform practice it will also satisfy the political imperative to have access related data to meet the needs of healthcare administrators, governments, and funding bodies. Our profession, our patients, and ultimately our administrative and funding bodies are rightfully demanding more. The Respiratory Therapy Practice-Based Outcomes Initiative (RT-PBOI) was implemented to explore, measure, evaluate, articulate and foster the value that respiratory therapists contribute to the provision of evidence-informed respiratory care. Partnering RT-PBOI organizations (Alberta Health Services, College of Respiratory Therapists of Alberta, Canadian Society of Respiratory Therapists) are collaboratively seeking to examine the value that respiratory therapists contribute to health care teams and patient outcomes in the provision of respiratory care. RT-PBOI is committed to addressing the challenge of translating this knowledge into action at the patient outcomes level as well as at the administrative level. This project seeks to create a process that is active and responsive to the changing needs of patients and the landscape of health care in Alberta., BACKGROUND As a requirement for a Masters in Leadership studies, an action research project was conducted in partnership with Thompson Rivers University (TRU). This partnership resulted in a desire to focus on RT students and community settings. OBJECTIVES This research sought to examine how the TRU RT program could improve the readiness of its graduates to work in Community Settings. This required the examination of current attitudes amongst student and practicing RTs in regard to community roles and settings, particularly when compared to acute care settings. METHODS A sequenced, multi-method approach of surveys followed by focus groups was conducted. Surveys were distributed to three separate groups: current clinical TRU RT students, current pre-clinical RT students, and all current registered RTs in BC. Following survey collection two focus groups were conducted. Participants from five distinct groups were invited: current TRU RT program staff, current Clinical Site Coordinators, experienced RTs currently working in community settings, recent graduates from the TRU RT program currently working in community settings, and current employers of RTs in community settings. RESULTS One hundred ninety-seven currently registered RTs and 12 current clinical TRU RT students participated in the survey. A total of 10 participants took part in two focus groups. Amongst those surveyed there was general agreement on community setting roles and challenges when compared to acute care. Interests and disinterests in Community and Acute Care Settings were varied and often contrasting, and RTs became interested in Community Settings for many reasons. DISCUSSION While there existed a wide and often contrasting variety of attitudes towards community settings, the majority of respondents saw Community Settings as interesting and challenging. This was made more significant by the fact that the majority of respondents self reported as working in acute care settings. Additionally, amongst Community Setting stakeholders there was a strong desire for change when it came to improving the readiness of future graduates to work in Community Settings CONCLUSIONS Results suggest that a majority of RTs in BC see Community Settings as an interesting and challenging setting to work. To support anticipated increases in opportunities and complexities within Community Settings, changes to how graduates are prepared are needed., AIM This talk will present the methods and study design for a follow-up validation study to “Pediatric respiratory therapy (RT) education: a comparison of clinical versus simulation-based training,” which aims to examine evidence of validity and feasibility of the Pediatric Airway Simulation Scoring Rubric (PASSR) for use as a tool to assess the effectiveness of individuals performing a pediatric airway simulation. Additionally, we will discuss the practical applications and potential limitations of the original study results that examined student respiratory therapists’ (SRTs) pediatric rotation. Lastly, we will reflect on our experiences as RTs involved in the research process. METHODS The PASSR validation study is a prospective observational multi-centre study. Participants include practicing registered RTs from SickKids and student RTs from Michener Institute of Applied Health Sciences, Canadore College, and St. Clair College. Level of participant expertise is defined by RT practice experience: novice (SRTs with knowledge though no pediatric clinical experience), intermediate (SRTs who have completed pediatric RT training) and experienced (practicing pediatric RTs). Participants complete a demographic questionnaire and a high-fidelity pediatric airway simulation scenario involving airway management of a child with a fever who seizes. Participants are expected to demonstrate bag-valve-mask ventilation, communicate with a confederate physician the need for intubation, prepare intubation equipment, and assist the physician with intubation while identifying and correcting common procedural errors. Simulations are video-taped and rated by two blinded experts and two live experts during the scenario using the PASSR. Evidence of validity and feasibility of the PASSR will then be evaluated. DATA COLLECTION To date, we have enrolled 64 participants with a target sample of 85. Data collection for 55 intermediate participants is complete; we are aiming to finish data collection for the remaining 21 participants (9 novice and 12 expert) by June 2019. IMPLICATIONS Establishing evidence of validity, and feasibility of the PASSR will support use of the tool for the assessment of both student and staff performance with respect to airway management in a simulated setting., Home ventilation devices for non-invasive ventilation are being used increasingly for many years across Canada. They are used for treating different types of respiratory problems. This presentation will cover the use of Bi-level devices for treating chronic hypoventilation, and how it can affect adult and pediatric patients. It’s important to understand the different pathologies touching these patients as it is important to know how these Bi-level devices work and the data they are providing. Bi-level devices provide us with ventilatory data using different software platforms. The question is, what can we do with this data and is it advantageous to use them in the follow-up of the patient at home? This workshop will provide an introduction to the different types of pathologies requiring home ventilation from a long-term perspective and a download interpretation workshop with the two manufacturers providing Home Bi-level devices in Canada. At the end of the workshop, the participant will be able to recognize who are the patients at risk of chronic hypoventilation and what are the first steps to take in regard to the data provided by the Bi-level devices., Respiratory therapists, whatever their role, work with people, and frequently these people need to make a change in their life, e.g. quitting smoking, taking medications, using oxygen, studying for an exam, passing a practical assessment. Cognitive behaviour therapy takes a practical approach to solving problems that prevent behaviour change, including unhelpful thoughts, unconscious or conscious beliefs, CBT helps people examine what is happening in their lives, their interpretation of what's happening, and their response. By breaking down these factors, using problem-solving and other concrete techniques, CBT provides skills that allow people to make good choices and sustain healthy behaviours. This workshop will use experiential learning (observation, activity, reflection) to explore the use of cognitive behavioural therapy (CBT) in respiratory therapy education. The workshop will begin with a short didactic session covering information about CBT (what it is, its pros and cons). Case scenarios and large group discussion will be used to allow participants to examine the links between how thinking and feelings drive behaviour, and how behaviour drives thinking and feeling in both our clients' and their own lives. Small groups will work through various cases and examine various strategies that can be and are currently being used in respiratory therapy to facilitate change in thinking and behaviour through cases. Opportunity for observation and practice will be provided through simulation. The workshop will end with time for participants to reflect on how this approach applies to their practice., Communication disability is prevalent among patients in the intensive care unit (ICU), due in part to the nature of intubation for mechanical ventilation and the ICU environment; frequent sensory, motor, language, and/or cognitive comorbidities in critically ill patients; and the limited systemic supports currently in place to facilitate effective patient-provider communication. Communication disability is associated with negative psychological and behavioural impacts and with reduced quality of care for patients. Difficulty communicating due to mechanical ventilation is reported by patients as the most distressing and most remembered symptom experienced while in ICU, and is consistently associated with increased levels of frustration, anxiety and sleeplessness in this population. Nonspeaking mechanically ventilated patients are typically limited to communication using nonverbal responses to yes/no questions, mouthing words, and gestures. Other strategies are seldom employed and when they are implemented, exchanges are brief in length, mostly nurse-directed, and rarely result in the patient’s complete message being understood. To improve the frequency and quality of communication interactions between healthcare professionals and mechanically ventilated patients, St. Paul’s Hospital implemented an Augmentative and Alternative Communication (AAC) intervention program. The pilot program is driven by an interdisciplinary team of nurses, respiratory therapists, and speech language pathologists. The strategies implemented by this team include: communication training for ICU staff, creation and placement of a Communication Access Cart in the ICU, and bedside SLP consultation. This presentation will provide an overview of developing an AAC intervention program. It will explore the strategies and tools used to facilitate communication between patients receiving mechanical ventilation and care providers and will share the successes and challenges of this important work., The goal of this workshop is to connect with health professionals about why mental health and wellness is important to them and to those they interact with. By building awareness and skills, health professionals can identify that mental health is not something that should solely be focused on when one has a problem, but that mental wellness is something that should be fostered and built upon like physical health. By making mental health an approachable topic – through definition, discussion and exploration – the health professions can improve communication and trust within their professional teams and equip them with skills to address their own, their colleagues and their patient’s mental health and wellness. The Council of Ontario Universities published a study related mental health and addiction strategies in 2017 citing that mental health challenges are one of the most pressing issues in post-secondary education. By looking at the responses and needs of the post-secondary learners, it is possible to extrapolate that the newest members of our professional teams, established practitioners, and our patient populations will be experiencing similar challenges with mental health and wellness. By identifying personal barriers to achieving effective ways to address these challenges in our lives, we can better understand mental health and wellness., Have you ever asked yourself why is there so many concerns with a patient with a pacemaker? How long do pacemakers last for? How does a pacemaker function and what do all the letters mean when referring about a pacemaker? Why is the patient’s heart rate low if they have a pacemaker in? Why do anesthesia assistants need to know about patients with pacemakers and what is the difference between a internal cardiac device and an implantable cardiac defibrillator? Hemodynamic stability is something that an anesthesia assistant is tested to help maintain on a daily basis. Knowledge of the normal cardiac cycle and rhythm interpretation is part of the daily monitoring that we do on each of the patients that we see every day. When patients enter the operating room and they have a pacemaker or a defibrillator implanted, what are some of the basic pacemaker/defibrillator tips that can help you in caring for these types of patients. Are there any concerns that the team should be aware of when dealing with a patient that has an implantable device in their chest? It is seen more often now, that more patients of all age groups are coming to the operating room with some sort of “cardiac” device inside their chest. What implications does cautery have with pacemakers? What about when someone has an implantable defibrillator and cautery is needed. Is there something that needs to be done to the device? Can you shut a pacemaker or a defibrillator off easy? Cardiology or cardiology techs are not staffed at all sites or work the night hours when fewer people are around, so having some basic pacing knowledge could help you in the future with patient care. A patient needs to go for an MRI and they have a pacemaker/defibrillator in. Are pacemakers/defibrillators safe in this setting? As a profession that assists with remote procedures, having the knowledge of what these devices do is essential is patient care and safety. There are many topics regarding pacemakers and anesthesia that will be discussed in this talk. Some case examples will be presented and reviewed to highlight some important points that have been discussed., On June 17, 2016, the Federal Parliament of Canada passed Bill C-14, establishing the legislation to regulate the practice of MAID Medical Assistance in Dying. There is a very well-defined legal frame work on how MAID is administered, who can provide the service, informed consent, eligibility criteria, waiting period and choosing to withdraw from MAID, monitoring and reporting on medical assistance in dying and independent reviews, and conscientious objection. Ontario has legislation that mandates MDs to inform the Trillium Gift of Life Network if they know about any death that could result in organ or tissue retrieval so the TGLN can ask the patient and family about organ donation. This includes MAID patients. As such we are starting to see organs being donated from MAID patients and their care from end of life to organ retrieval is being carried out in the perioperative setting. Anaesthesia Assistants working the in the perioperative setting may be asked to participate in this process by providing technical assistance to the MAID and TGLN teams for vascular access and/or arterial line insertion for blood pressure monitoring and blood sampling during the MAID process. For patients that are lung donor candidates the anesthesia care team may be ask to support the MAID and TGLN Teams with lung care post pronouncement of death which includes ETT intubation and alveolar maintenance and lung recruitment via mechanical ventilation therapy until the lung(s) are surgically retrieved. This talk will discuss the role of AAs during the perioperative care of MAID patients that have chosen to donate their organs post death and review the interoperative protocol for lung retrieval., With the advent of the regulation and legalization of the sale of Cannabis for recreational use in Canada it is anticipated that there will be a dramatic increase in the consumption and use of Marijuana in a variety forms in the general population. This has created growing concerns that more patients may present to OR under its influence either acutely intoxication and or chronic use and little is understood about perioperative anesthesia considerations and risks. Anesthesia Assistants are front line anesthesia care providers and will experience caring for patients that are acutely intoxicated or chronic users of marijuana. AAs should endeavor to understand the potential perils and pitfalls of the use of Cannabis in the perioperative setting and how its use can impact the perioperative anesthesia care plan and patient safety., In the most remote areas of Northern Canada, respiratory therapists are sometimes battling extreme cold and limited personnel, supplies and equipment for medevacs that present with their many challenges. From relying on word of mouth and a simple triage in order to prepare for a possible critical situation, to being pushed out of the comfort zone of basic day to day by having to perform the most advanced skills of the scope of practice. The need to think about the logistics of space and the lengthy flights may also present an issue. Working as a team with the flight nurses and medics, the respiratory therapist shows flexibility and must be accommodating to the whole spectrum of patient population; proving that they play an integral role in the critical care team. From preterm births thousands of kilometers from tertiary care, bronchiolitis and RSV in pediatric patients, to traumas, head injuries, and complex overdoses in adults, the respiratory therapist skillset, knowledge and expertise have been found to be a valued part of the critical care air ambulance team in Nunavut. Many Canadian air ambulance services use Flight Nurses and Paramedics exclusively for their patient care. This presentation will discuss how and why the role of the respiratory therapist has become so essential in the North, and the opportunities this presents for the profession in the future., Family presence during resuscitation (FPDR) is a recent topic of interest within the field of patient-centered care. Research regarding feelings and impact of FPDR towards healthcare workers, family members and patients has been lacking. This presentation focuses on the impact of FPDR on all three groups of individuals involved. The majority of Healthcare workers have witnessed FPDR and yet they believe that there are barriers that prevent them from implementing it and it may hinder their ability to perform to their best ability. Family members have their own barriers put on them by the perceived risks by healthcare workers despite their wanting to be present. Mental health detriments are one of the risks put forward as a barrier for FPDR despite the research showing that there is improved mental health outcomes post FPDR. Patients perspective is a interesting one as its unlikely their wish for FPDR has not been vocalized prior and survival rate is low but it still important to allow the patient to maintain autonomy during FPDR. Improvements that increase the frequency of FPDR are educating healthcare workers on the topic, having policies and support workers for the family during the resuscitation. Overall healthcare workers can be approving of it pending the installment of improvements within their care center and they can see the benefits of FPDR. Family members may fare better after losing their loved ones when they participate in FPDR with lower anxiety and PTSD rates and patients approve of their family members being present as long as it does not interfere with their care. Due to this, FPDR is a practice that should be initiated in all health centers due to the high chance of benefits and low risks., Today, various inhalers and anti-inflammatory medications are the mainstay of asthma management. These have unarguably shown great success in reducing exacerbations worldwide. With this being said, we now know Asthma control involves a much more multifaceted approach, including not only physiological control, but also lifestyle adaptations. Triggers vary person to person and can range from purely environmental, such as an allergen exposure, all the way to anxiety-induced exacerbations. This therefore provides a challenge for Respiratory Therapists to find what management options works best for their patient. But what options are people using to complement their current therapy, and do they really work? This brings to light the controversial topic of complementary and alternative medicine. The key word is “complementary” as oppose to “alternative,” meaning that their uses are being done alongside your prescribed inhalers. When it comes to supplementing Asthma treatments there are many different therapies available, three popular ones include: Halotherapy, Acupuncture and Mindfulness meditation. This presentation will explore recent evidence-based research done on each of the three proposed therapies, as to discuss their efficacy for managing respiratory symptoms associated with chronic Asthma. This topic is of importance because if beneficial, it may lead to an overall improvement in quality of life for asthmatic patients. Not only this, but it can be a safe add-on that Respiratory Therapists or other health care professionals can recommend to further the chances of symptom control on top of regularly taking bronchodilators., Healthcare is fast becoming increasingly complex. Daily, all members of the healthcare team must prepare graduates who are “adept at coping with the growing body of knowledge, rapid advances in science and technology as well as the economic constraints that continue to result in massive health care changes” [1]. There is a daily challenge to prepare clinically competent practitioners who not only must survive, but also thrive in an ever-changing, multi-faceted system. Preceptors play an important role in the transition of students / interns to the practice setting. However, the preceptorship experience has been perceived as challenging and stressful by preceptors. One research study suggested that the role of preceptorship “requires considerable time and effort” [2 p. 93] and preceptors often find it difficult to balance their “caring and teaching roles without compromising one or the other” [2 p. 92]. It is a fact that preceptors influence students by acting as role models, “socializing” students into the workplace and supporting their acquisition of knowledge, skills and attitudes. For students to develop a strong identity as a Respiratory Therapist, they need early and frequent exposure to excellence in practicing professionals. Consideration must be given to find ways to facilitate connections between students and RTs which will foster realistic expectations for students. Preceptors must be learner focused, the way they are client-focused [3] and must be empathetic towards learner needs. The preceptor’s ability to consider clinical situations with an open mind and from several perspectives that will enable students to develop their own critical-thinking abilities. Actions, specifically the manner in which the preceptor interacts with colleagues, patients, families, physicians, and other health care professionals, demonstrates professionalism. To be professional is also to be knowledgeable about the precise work of a Respiratory Therapist, while being respectful of patients and coworkers. To be professional is to be ethical in practice, to be prudent and careful in clinical judgments and to possess a large measure of practical wisdom. Students look to their preceptors for their ability to handle situations and put considerable faith in their wisdom as a practitioner. Being a preceptor requires commitment to intentionally share knowledge and expertise with others., M. came to Tenwek Hospital after being involved in a motorbike accident 10 days prior. She seemed to have a normal clinical course; however, post-op, was failing her daily Spontaneous Breathing Trials. Her caregivers were stumped. Different differential diagnosis were tossed around, cervical spine injury from the accident – but the CT was normal, Phrenic Nerve injury but from where? In a hospital where resources are limited, finding a diagnosis is hard. You are limited by the number of ventilators and no long-term care units to accept long term ventilated patients. The staff needed a diagnosis to make a prognosis. The staff continued to ponder and the RRT reached out on social media with a brief description of symptoms. An RRT from back in Edmonton responded – what about wound botulism? This talk will also explore what it is to be the only RT in a 300-bed hospital in rural Kenya. Annette Lievaart has had to create a role for herself. This discussion will explore the balance between education and work. Encouraging others who do not have RT training to be comfortable with Ventilators, ABG’s and other skills that RT’s generally are responsible for., BACKGROUND While the regionalization of pediatric critical care services that improved care and outcomes for critically ill children, as many as 50% of critically ill children require resuscitation and stabilization in regional or community hospitals prior to their transfer/transport to pediatric tertiary care centers. It is thus imperative for healthcare providers who work in non-pediatric hospitals who care for pediatric inpatients to have pediatric assessment and recognition skills, as well as the capacity to initiate the management of critically deteriorating children. This is especially important in regional or community hospitals, which will require intra-facility transport. In fact, the Canadian Pediatric Society has come out with the position statement that “Hospitals caring for pediatric in-patients should implement and train Rapid Response Teams (RRTs) with expertise in pediatrics.” This presentation will share with members of the CSRT skills to adapt existing adult-focused RRTs/METs, in order to meet pediatric specific needs surrounding the assessment, recognition and early assessment of the clinical deteriorating child. RATIONALE We believe this presentation will be of interest to the members of the CSRT since: There are limited resources and funds for pediatric specific MET/RRT programs While most centers have METs/RRTs, they may lack the experience and resources to care for critically ill children, including a lack of expertise in the pediatric assessment, recognition and initial management We believe that it is possible to adapt existing programming, and develop tools to help adult METs/RRTs assess and manage pediatrics patients TAKE HOMES OF PRESENTATION Following our presentation, viewers will be more versed in: Early identification of children who are at high risk for clinical deterioration Recognition of early signs and symptoms of the clinically deteriorating pediatric patient, and when to seek assistance Knowledge surrounding management of common critical pediatric-specific conditions Adapting existing MET/RRT infrastructure to better support education, identification and early management of the critically ill pediatric patient, BACKGROUND Cystic fibrosis (CF) is an autosomal recessive disorder with respiratory, pancreatic, hepatobiliary, gastrointestinal, renal, endocrine, and genitourinary complications, with 90% of patients dying from pulmonary infections. The disease process consists of recurrent pulmonary exacerbations requiring intensive treatments and once resolved, time-consuming and physical exhausting therapy is required. DESCRIPTION It is important to recognize the challenges associated with providing proper palliative care for the CF population. Palliative care is initiated when end-of-life is approaching but for cystic fibrosis patient, this time-line is uncertain. Methods to predict mortality include Liou’s 5-year survivorship model, a “parsimonious” modified Liou’s model using four of the nine prediction factors, and predicted vs actual FEV1. These methods are dated and flawed in their efficacy of predicting mortality. Additionally, CF patients undergo daily intensive therapies including, and not limited to, chest physiotherapy, inhaled medications, and antibiotic administration. The challenges with the intense daily regime include denial, where patients see treatment as a cure, and defeat, where the treatments become a significant burden and the patient decides to terminate all, or select treatments. The creation of a “concurrent care” model would provide immense benefit; rather than passive participation in palliative care efforts, CF patients would be encouraged to be active in their care. The creation of educational tools and courses to educate healthcare professionals on the proper time to discuss palliative care, and how to carry out these conversations. CONCLUSIONS When discussing the importance of palliative care, it is important to remember that delayed or improper care can have negative effects on the patients’ health throughout the terminal disease phase as well as hinder family coping. As members of the CF multidisciplinary care team, respiratory therapists must recognize the importance of proper palliative care and ensure the expectations, goals, and wishes of the patient are being respected., Post-operative pulmonary complications are known to have a big impact on morbidity and mortality in many patients undergoing invasive surgical procedures. These complications increase hospital length of stay and resource utilization. Preoperative pulmonary rehabilitation (“pulmonary prehab” or “PR”) has been identified as a potential way to avoid these impacts and mitigate recovery complications in at-risk patient populations. Positive prehabilitation results in the fields of open-heart, abdominal and orthopedic surgery has prompted research into the benefits for patients undergoing lung resection procedures. Recent studies show promise that PR can be similarly effective in reducing post-operative complications in lung cancer patients. With these results and recent increased interest surrounding PR, RTs may have a future role in promoting, assisting and/or evaluating patients undertaking pulmonary prehab regimens in preparation for invasive surgery., Chronic Obstructive Pulmonary Disease (COPD) clients frequently present with dysphagia which often can leads to exacerbation such as aspiration pneumonia and possibly hospital admission. In fact, COPD exacerbation is a leading cause of hospital admission and it is associated with longer hospital stays, increased intensive care admissions and mortality. COPD has a significant impact on the healthcare system not only in Canada but also globally. It is crucial for both COPD clients and the healthcare system to prevent this condition in the community setting. In a rural community setting, it is typical to have a shortage of clinical rehabilitation specialists, such as speech-language pathologists. Because of this, dysphagia symptoms may not be identified until they are severe. Pulmonary rehabilitation programs often include this issue through the nutrition education component, but it is minimally introduced to COPD clients. The Eating Assessment Tool (EAT-10) is a screening tool used to identify clients with dysphagia. If a score of 3 or higher is recorded, further dysphagia assessment is suggested. It is a rapidly administered, simply calculated, and easy to use scale which has excellent internal consistency, test-retest, reliability and criterion-based validity. The presenters will discuss on how dysphagia can lead to COPD exacerbations and how early intervention may prevent future complications like aspiration pneumonia. The presenters will also discuss the integration of the EAT-10 into a routine respiratory assessment in a rural community setting., Despite access to several tools, resources and guidelines, significant barriers exist for Respiratory Therapists to effectively use dyspnea management strategies in several practice settings. Barriers include; patient decisions that deviate from evidence-based medicine, knowledge on interprofessional practice, and physician medication ordering practices. A linear approach simply wouldn’t address the complexity, so our team had to come up with a creative online solution. The Dyspnea Management Project developed a gamification strategy within an online learning system to address a variety of knowledge gaps in Dyspnea Management. In this session we will briefly review the current literature and practice tools on dyspnea management, as well as how to modify a gamification strategy to incorporate respiratory therapy practice grounded in clinical storytelling. The rest of the session will focus on how branching logic was critical in the development of the module, and advice for those who may want to build their own gamification strategy for an online learning initiative., In the constantly-evolving worlds of sleep medicine, PAP therapy and home oxygen, there are many tools available that patients can utilize on their own, supplemental to their clinical treatment. The home care environment is changing as technology becomes more accessible to patients, but what are the benefits, and what are the risks of patients having access to their own information? Several studies suggest that the more patients are engaged, the more likely they are to comply with the recommendations of their healthcare professional. But is too much information a barrier to proper treatment? In this session, we will review the current literature on patient compliance and explore how it applies in the home care setting. Taking this one step further, we will then review a variety of tools that assist patients in the home with PAP compliance and oxygen therapy. These tools include proprietary software from PAP manufacturers as well as non-proprietary software for patient use. This session will also cover a review of a therapy developed by Dr. A Lohmann, a discussion on the benefits of pulmonary rehab as it relates to home oxygen compliance and a review of home SpO2 monitoring for oxygen patients. We will conclude our session by examining the benefits and risks of each tool from the perspective of both the patient and healthcare practitioner, including a couple of case reviews showing the impact of patients taking control of their own health in the home care setting., Working in a busy trauma centre, treatment of devastating c-spine injuries can be common. Often it is difficult for these patients to regain a sense of purpose and quality of life. One such way to return autonomy to these patients is to help them achieve the abilty to speak while on mechanical ventilation. The respiratory therapists in the Tory Trauma Program at Sunnybrook Health Sciences Centre in Toronto have developed an algorithm to restore speech in approriate chronically ventilated patients. This may involve the use of a one-way valve in the ventilator circuit along with various ventilator setting adjustments to achieve the optimal amount of flow through the patient’s upper airway in order to vibrate the vocal cords, thus producing phonation. The process for producing speech in these chronically ventilated stable patients along with safety considerations for using this approach will be discussed., Acute Chronic Obstructive Pulmonary Disease (COPD) exacerbation requiring hospital admission continues to be a challenge to manage while in hospital as well as post discharge into the community. Healthcare organizations are continuing to look at ways of efficiently and safely managing these patients through patient specific care plan development and organizational best practices to improve length of stay, decrease readmission and overall, provide exemplary patient experiences. Halton Healthcare introduced a corporate Innovation Grant program as part of our commitment to one of our strategic priorities, Innovation. This grant fosters an environment of continuous learning and innovation, and embraces the spirit of discovery. The RT department at the Oakville site used this grant to implement and evaluate the standardized use of nasal high flow therapy to treat admitted COPD patients for their duration of stay in hospital and further provide an opportunity for these patients to have access to this therapy at home throughout their ongoing recovery. This presentation will discuss the implementation of this evaluation, barriers, learnings, and plans moving forward on how we will provide care for this population in the near future., Endotracheal intubation and mechanical ventilation are lifesaving interventions that are commonly done in the intensive care unit (ICU). The act of intubating someone can cause laryngeal edema that, if extensive enough, can result in airway obstruction after a patient is extubated. To date, the only test that is available to predict this complication is the cuff leak test (CLT), however, its diagnostic accuracy is uncertain as there have been no randomized controlled trials (RCT). This multi-center, pragmatic, double blinded pilot RCT is currently enrolling mechanically ventilated ICU patients deemed ready to be extubated at three centres in Canada, Saudi Arabia, and Poland. All eligible patients have a CLT done prior to extubation. The results of the CLT in the intervention arm are communicated to the treating physician, and the decision to extubate is left to the treating team. The results of the CLT for patients in the control arm are not communicated to the treating physician, and the patient is extubated as per extubation order, regardless of the CLT results. Although clinical outcomes relevant for a future, larger COMIC RCT will be examined, the primary outcomes of the COMIC Pilot Trial are feasibility outcomes including: consent rate, recruitment rate, and protocol adherence. Clinical outcomes will include postextubation stridor, reintubation, emergency surgical airway, ICU mortality, in hospital mortality, duration of mechanical ventilation, and ICU length of stay. Herein, we report the protocol for the cuff leak and airway obstruction in mechanically ventilated icU patients (COMIC) Pilot Trial, and discuss the feasibility of conduction a powered RCT to examine the impact of CLT on postextubation stridor and reintubation., No one understands how to ventilate a patient as safely and effectively as a Canadian Respiratory Therapist! Their superior knowledge and technical expertise positions them uniquely to be able to care for critically ill patients with as few sequelae as possible. The nature of this care attracts and develops strong creative problem-solving skills, and these are the skills that are vital to translating ideas into practice. Translational research involves taking an idea about physiology or equipment and applies that knowledge into new practice in order to improve outcomes. Much of the ventilation research that happens, happens outside of Canada and these research teams do not include RT’s. Once of the most successful ventilation research teams in the world is based in Toronto and does include an RT as senior member of the team. RT participation in world class research, particularly translational research, adds the unique hands on experience and a fundamental wealth of ventilation research knowledge. This will ensure that new methods and ideas will be practical and have a lower barrier to acceptance because the end-user has been part of the development. Stepping up into research and practice development roles will also provide role models and help create other avenues of professional pursuit outside of current front-line acute and community roles. This will raise the profile of our profession and we will no longer be the best kept secret of the ICU and rather be the front-line champion to new practice., BACKGROUND In the last 10 years, the number of deceased organ donors has increased by 42%. The number of people waiting for a transplant also increased during this period. The donor rate in Canada is still lower than that of several countries including the United States. Despite the fact that half of Canadians are able to donate blood only 1 out of 60 has done so. This raises several questions. OBJECTIVES To present some of the current statistics on organ donation, to present the challenge of medical aid in dying and organ donation and to promote the involvement of the respiratory therapist within the process. DISCUSSION A donor can save up to eight lives, improve the quality of life for up to 75 people and allow countless families to benefit including the loved ones of those who are awaiting an organ. What reflections can be made regarding the approach to medical assistance in dying?, This lecture explores areas of potential physiological interaction with positive pressure ventilation. Images and subpleural microvideographs are used to highlight the consequences of this interaction. Current research will present the relative risk of death either increasing or decreasing depending on ventilator strategy. The effects of MAP on Preload and Afterload will be reviewed, as will the surprising impact of NIV on lung disease prevention. The lecture will conclude with instruction on the most efficient techniques for optimizing lung inflation while minimizing the harmful effects of mechanical ventilation., A retrospective view of one Neonatal Intensive Care Unit's experience around the resuscitation and ongoing care of a 22 week neonate. Beyond the concern for the health of an extremely premature infant at the time of delivery, thought must be given to their prolonged hospital stay and long-term recovery. In addition, the wellbeing of the families and healthcare providers of these infants must be taken into consideration. The presentation will discuss current recommendations around resuscitation based on gestational age and changes of viability over time. Current practice in regard to code status and terminal wean will be explored. The ethical ramifications that evolve from resuscitating and caring for extremely premature babies will be considered along with dealing with end of life. The case of one 22 weeker in our NICU will be reviewed from both a clinical point of view but also from the lens of my personal experience with the baby, his family and the other health care team members., Asynchrony during invasive mechanical ventilation is one of the most common issues in the intensive care unit. The presence of significant asynchrony has been shown to be associated with worse outcomes including length of mechanical ventilation, ICU stay, and mortality. Asynchrony is poorly recognized due to the requirement of visual detection, which is not possible at all times. This presentation will describe some of the technology currently available for detecting asynchrony, and the work currently being done to make them more accurate. Additionally, this presentation will include an interactive session for identifying and correcting common forms of patient-ventilator asynchrony., Le débriefing est une étape cruciale dans la clarification et la consolidation des apprentissages effectués au cours d’une séance de simulation. Il s’agit d’examiner méthodiquement ce qui s’est passé et pourquoi. Mais comment peut-on assurer un reel transfert des apprentissages du contexte d’enseignement vers un contexte réel ? Cette présentation permettra d'explorer les diverses approches de débriefing et leur utilisation en fonction du context d'apprentissage. Elle détaillera les éléments clés des trois phases du débriefing, ainsi que les stratégies efficaces pour favoriser le transfert des apprentissages vers un contexte réel. Cette présentation abordera aussi les éléments essentiels pour établir un climat propice à un débriefing constructif., L’utilisation de l’empathie lors de soins chez un patient instable n’est probablement pas votre premier réflexe. Pourtant, utilisé de la bonne manière, elle peut potentialiser les traitements pharmacologiques, favoriser la stabilité hémodynamique, améliorer la qualité de l’anamnèse et même induire le soulagement de la douleur. Cette présentation vise à démontrer comment l’utilisation d’une approche axée sur 7 critères peut améliorer la qualité des soins sans pour autant alourdir ou modifier drastiquement vos habitudes. Elle vise également à démystifier les préconceptions reliées à l’empathie et à son usage lors des traitements, et ce, avec un brin d’humour et de biologie., Les vasodilatateurs pulmonaires inhalée, une bête noire lorsqu’il est temps de les administrer en inhalation. Depuis les 3 dernières années, il y a eu plusieurs études qui ont démontrées que les traitements de vasodilatateurs pulmonaires inhalées devraient être plus présent lors des chirurgies cardiaques et en soins intensifs afin de prévenir plusieurs complications due à l’hypertension pulmonaire. Venez découvrir, les différents vasodilatateurs pulmonaires et leurs particularités. Ainsi, que les différentes techniques utilisées en anesthésie et aux soins intensifs à l’Institut de Cardiologie de Montréal., BACKGROUND Pulmonary function tests (PFTs) help determine a patient’s candidacy for cardiac surgery; however, their predictive value on postoperative outcomes is unclear. METHODS We performed a systematic literature review and study-level meta-analysis of prospective trials evaluating patients undergoing all types of cardiac surgery. We assessed the predictive values of PFTs on each of the following outcomes: mortality, ventilation time, hospital length of stay (LOS), intensive care unit (ICU) LOS and major adverse cardiovascular events (MACE). Abnormal PFTs were defined as GOLD spirometry criteria ≥2. We used eight strategies to identify eligible trials including bibliographic database searches of MEDLINE, PubMed, EMBASE and the Cochrane Controlled Trials Registry until December of 2018. Two independent reviewers undertook decisions about study eligibility and data abstraction. Data were pooled using a Mantel-Haenzsel random effects model and statistical heterogeneity was also calculated. Point estimates are reported with their associated confidence intervals (CI). RESULTS Nine prospective trials fulfilled our eligibility criteria representing 37,484 patients. We detected an increased mortality with abnormal compared to normal PFTs (2640 events; RR, 2.08 [CI, 1.28–3.38]; I2 = 62%; p = 0.003). Abnormal PFTs also predicted a prolonged ventilation time exceeding 24 hours (242 events; RR, 2.64 [CI, 1.96–3.56]; I2 = 0%; p ≤ 0.00001) and hospital LOS exceeding 7 days (384 events; RR, 2.95 [CI, 1.63–5.35]; I2 = 68%; p = 0.0004). There was no statistically significant difference in ICU LOS greater than 24 hours (401 events; RR, 0.85 [CI, 0.40–1.83]; I2 = 68%; p = 0.68) or MACE (1517 events; RR, 2.83 [CI, 0.86–9.30]; I2 = 94%; p = 0.09). CONCLUSION Abnormal PFTs were associated with increased mortality compared to normal PFTS. Additionally, abnormal PFTs were associated with increased hospital LOS and increased ventilation time. Abnormal PFTs were not predictive of ICU LOS or major adverse cardiovascular events. The implementation of PFTs prior to cardiac surgeries has shown great promise as a tool for determining candidacy for patients undergoing such procedures., Amyotrophic lateral sclerosis (ALS) is a progressive and fatal disease of upper and lower motor neurons and, in most cases, death occurs from respiratory complications. The incidence rate of ALS is estimated to be 2/100,000 people per year and approximately 2500–3000 Canadians over 18 currently live with ALS. Non-invasive ventilation helps with the respiratory symptoms for ALS clients if their disease starts to progress and show remarkable respiratory symptoms such as orthopnea. Monitoring respiratory status is therefore critical to ALS management, as pulmonary function test are used to make decisions including when to initiate noninvasive ventilation. Maximal inspiratory and expiratory pressures are also vital in ALS monitoring but in some cases are difficult for clients that already lost their facial movement such as for bulbar ALS clients. Supine spirometry is a cheap and easy technique that can provide useful information towards diagnosing and monitoring diaphragmatic dysfunction mostly ALS. The presenter will discuss the benefits of supine spirometry as an integral part of a respiratory assessment in a community care setting especially with rural population. The presenter will discuss the important and integral FVC percentages that is very crucial to determine the proper respiratory symptom management for ALS clients such as noninvasive ventilaton and cough assist machines. The presenter will also discuss the procedures and processes on how to do supine spirometry in a community setting. The purpose of the presentation is to provide clinicians realistic perspective on doing supine spirometries in rural community setting in terms of procedure, processes, and all other different barriers that the community respiratory therapist faces on everyday work routine., INTRODUCTION Health care workers experience stress in their work environments on a daily basis. Some stressors are beneficial, others can be debilitating. Introducing a peer support team like a CISM team can help reduce stigma, boost morale, increase resiliency and decrease burnout within a unit. These teams are very prevalent and studied with EMS, military, police and fire services, but there is not much research with regards to using CISM teams in ICUs for health care workers. METHODS Pre-staff surveys and unit data collected before introduction of a multidisciplinary CISM team in NICU. CISM team initiated by steering committee using adaptive change techniques and collaboration with ACH and UAH PICU CISM teams. Team formed with application forms, grading system and references. Training done by ICISF and team initiated into RAH NICU and DS NICU in November 2017. Now research looking at pre and post initiation staff surveys, sick time, burn out, CISM team usage and turn over. RESULTS Research stats unknown at this time, will come out in January 2019. Increased resiliency and morale noted on unit, with fewer needs for CISM intervention over the year. CONCLUSION CISM is well researched and proven effective in many high-stress careers, and we are looking to show the need for it in our work environment. Forming a team is no easy task, but with CISM introduced in a few centers now, we have some trial and error to share from our experiences. So far we have seen a real use for our team and will continue our efforts., Hospitals are high stress, complex areas of employment. Post-Traumatic Stress Disorder (PTSD) is a psychiatric condition following exposure to a traumatic event(s) that results in fear and helplessness, among other emotions. PTSD is a common occurrence in Respiratory Therapists who deal with traumatic and emotional situations on a regular basis. Our goal should be to increase the discussion and promotion of resources to deal with PTSD, to support the mental-wellbeing of our healthcare workers., The old adage that “change is the only constant” has never been more relevant in our personal lives and workplaces. Over time our personal response to change, and how we navigate through it, can make the difference between a downward spiral into a negatively distorted, cognitive and emotional reality that can fuel psychological and physiological stress, or it can create an opportunity to develop and enhance the behaviors, competencies, and mindset required to master, and even lead, the continuous change that will define our reality for the foreseeable future. Before we can embark on any journey forward we must first determine where we are. This presentation is designed to increase participants’ self-awareness of how they currently respond to change so that they can develop and refine tune their personal development strategy to become a more effective change manager or leader. The behavioral characteristics of three “change personality types” are introduced to discuss the situational context in which each response provides value. Four evidence-based practices utilized by change masters to build resilience through constant change are reviewed and discussed. The session will provide participants with supportive insight to build an action plan for improving personal resilience in order to manage themselves and those they lead more effectively., The Canadian Nurses Association defines violence broadly to include verbal and emotional abuse, physical violence and sexual harassment. Workplace bullying (including intimidation, harassment, victimization, aggression, emotional abuse, and psychological harassment or mistreatment) is included in this definition of violence. Workplace bullying in health and community care is now four times more prevalent than sexual harassment in this high-stress sector. This session aims to help the healthcare professional recognize acts of bullying in the healthcare environment; reflect on experiences as a target of, or silent witness to, bullying in healthcare; come to terms with the impact of workplace bullying on the target, the patient and the culture of healthcare settings; understand the legal ramifications of workplace bullying; and finally, analyze the parallels between post-secondary attrition and early workplace departure post licensure. The session will end with a discussion regarding creating a culture of belonging instead of accepting a culture of lateral violence., Lung volume reduction surgery (LVRS) is currently an invasive option for treatment of severe emphysema but in many cases it comes with an increase in morbidity and is limited in the type of emphysema it is able to treat. Recently, lung volume reduction via endobronchial one-way valve has become an increasingly inviting option as it has equivalent positive outcomes of LVRS with lower morbidity post procedure. This paper will discuss if endobronchial one-way valve lung volume reduction is a superior method of treatment in patient with severe emphysema when compared to other surgical interventions. Endobronchial one-way vales are placed in sedated and mechanically ventilated patients. Chartis balloon testing is done to determine if the target lung segment has any collateral ventilation with adjacent lung segments. Valves are usually placed in the upper lobes with flexible bronchoscopes causing atelectasis of alveolar acinus distal to the valve. Twelve months post procedure patients had clinically significant improvements in FEV1 and 6-minute walk test. Valve placement also showed increased quality of life using the St. George’s Respiratory Questionnaire. The most significant post-operative complication has been the development of pneumothorax. Lung volume reduction using endobronchial one-way valves has the effectiveness and limited adverse events to become a commonly used treatment option for patients with severe emphysema., The disease burden of asthma is significant worldwide. Asthma affects over 3 million Canadians [1] and continues to be a leading cause of hospitalization among children and youth with more than 6000 hospitalizations in 2015–2016 [2]. For every one of these hospitalizations, there were approximately eight emergency department visits [3]. The Emergency Department Asthma Care Pathway was developed as part of the MoHLTC Asthma Plan of Action in direct response to an inquest into the death of a teenager in 2000 from an asthma exacerbation. Research on current asthma practice in emergency departments show suboptimal use of objective measures, under-utilization of systemic steroids both in the emergency department, low referral rates to specialized asthma services and under-use of evidence-based guidelines [4]. The pathway is a standardized, evidence based clinical pathway for the treatment of acute asthma, developed and managed by The Lung Association – Ontario. The EDACP consists of two pathways: the pediatric and adult. Both clinical pathways are based on the Canadian Thoracic Society (CTS) asthma guidelines and other relevant clinical guidelines and literature. The pathways are designed to promote: appropriate assessment of the severity of the exacerbation; evidence-based asthma treatment; patient education prior to discharge; comprehensive discharge instructions; and arrangements for follow-up care. Implementation of the pathways is associated with a number of benefits including but not limited to reduced repeat emergency department visits and hospital admissions, potentially decreased length of hospital stay, improved asthma self-management and symptom control and improved efficiency in patient care and adherence to clinical best practice guidelines. Ontario hospitals will benefit from the adoption and subsequent implementation of the pathways., In 1958, journalist Andrew Genzoli reported a letter received from a reader reporting the discovery of large footprints found by loggers and the legend of Big Foot began. In the 1950’s, Dr E.J.M. Campbell delivered a lecture [1] to pulmonologists about the dangers and risks associated with giving too much oxygen in COPD, giving birth to the theory of “hypoxic Drive.” The lecture was based upon a study that included only four patients and that later studies could not replicate. Never the less, the hypoxic drive theory became the gold standard in the treatment of COPD patients. The premise to the development of the “hypoxic drive” is that of a progression of pulmonary disease characterized by the increasing demand to increase minute ventilation to maintain a normal PaCO2. As the disease progresses and the physiologic demand to increase minute ventilation exceeds the physiologic ability to meet the demand, something has to give. The patient slowly and progressively begins to drop their minute ventilation until they can successfully meet the ventilatory demands. This causes a drop in pH as the PaCO2 begins to rise with a concurrent drop in PaO2 [2]. The drop in PaO2 triggers the increased production of erythropoietin and this, in turn, causes the increase in red blood cell production. The increased RBC production allows for more production of HCO3- (bicarb) to buffer the effects of the elevated PaCO2 and maintain a normal pH [3]. The increased Hb levels also increases the transport capability of both CO2 and O2, maintaining a normal O2 content with minimal change in SpO2 or PaO2. At the same time, the lower PaO2 (55–60 mm Hg) provides stimulus to the peripheral chemoreceptors which, in addition to the stimulus to the central receptors by dropping pH, provides the stimulus to maintain the physiologic balancing act. The physiologic balance created by the compensation mechanisms is a very delicate balance requiring constant adjustment. Effects of increased metabolic activity (exercise, infection, increased work of breathing caused by acute progression of the pulmonary disease), impairment of ventilation (bronchospasm, inflammation of the airways), physical deconditioning (debilitating SOB limiting exercise), poor nutrition and respiratory depressives (e.g. Alcohol, narcotics, benzo’s) all effect the ability to maintain the balance. With the increase in RBC, the carrying capacity of CO2 increases and it is in this stage that the effects of oxygen come in to play. Although there is documentation supporting a drop in minute ventilation secondary to the administration of oxygen [4], this is usually self limiting. What the administration of oxygen actually does is to take advantage of hemoglobin’s stronger affinity to oxygen than carbon dioxide. The delivery oxygen in increasing amounts displaces more and more CO2 from the Hb increasing the PaCO2. This is known as the Haldane effect. If the pt’s pulmonary disease limits his ability to increase his minute ventilation in response to the rising CO2, the patient quickly becomes hypercarbic with a corresponding drop in pH. This drop in pH begins to impair respiratory muscles that are already severely challenged by the physiologic demands placed upon them. At the same time, oxygen being a very potent vasodilator causes pulmonary vessels constricted by a low PaO2, in an attempt to rebalance perfusion to unaffected lung tissue, to vasodilate [5]. This vasodilation causes increasing shunting with CO2 rich blood to bypass the alveoli and not allow diffusion out of the lungs [6]. This causes further progression in the rise of PaCO2. The delicate balance can easily be upset and often leads to occult ventilator failure at home. By the time the patient arrives in hospital the decompensation process has begun and requires prompt medical intervention, including oxygen administration. The effects combined result in a progressive and fairly rapid decline in the patients ventilatory status which has the potential to lead to complete ventilatory failure. Often, the patient has utilized all of their compensatory abilities to survive (prehospital) and the progression of failure continues in the acute phase of their hospital stay. Clinician’s often point to the administration of oxygen as being the cause. The hypoxic drive by itself in a very minor driver of the respiratory system but in the context of progressive failure prior to admission the effects of oxygen are multifactorial and do have a contributing effect to the speed offailure. Without complete medical treatment of the causes of failure the progression of failure is unrelenting – the speed of which is determined by the failure of compensatory mechanisms. While oxygen induced hypercapnia [7] is a multifactorial clinical reality, the “hypoxic drive “ theory is a Myth Take but still remains as an urban medical myth., Managing dyspnea in palliative patients is essential to providing adequate comfort and symptom control. Refractory dyspnea is defined as a debilitating symptom of advanced pulmonary and cardiovascular disease that is described by difficulty in breathing at rest or with minimal exertion, despite optimal therapy of the underlying disease. The purpose of this presentation is to look at the research and evidence behind the various options for managing dyspnea, and various perspectives on what provides symptomatic relief versus what prolongs the end stages of disease. There is a fine line between delaying the inevitable and supporting one’s comfort in the final days of their life. The evidence behind the following strategies will be discussed: oxygen therapy, pharmacotherapy, and various non-pharmacological interventions. Treating hypoxemia with oxygen therapy can provide no symptomatic relief for dyspneic patients, however treating non-hypoxemic patients with oxygen therapy can provide relief which supports the need for further clarification on the necessity of oxygen during palliative care. Ambiguity in regard to the evidence of pharmacotherapy for treating dyspnea is evident in various palliative care practice. Oral and parenteral opioid use of morphine and fentanyl in addition to anxiolytics may be used to manage dyspnea. Utilizing non-pharmacological interventions such as breathing and meditation strategies, and relaxation therapy may also be considered. Recognizing how to effectively manage dyspnea and clarify certain strategies that are currently available for palliative patients will be discussed. Perspective on managing dyspnea in regard to end stage Chronic Obstructive Pulmonary Disease (COPD) will be discussed., The risk of a “No Alarm” condition resulting from inappropriate alarm settings has recently garnered attention. “Improperly Set Ventilator Alarms Put Patients at Risk for Hypoxic Brain Injury or Death” is listed by ECRI among the Top 10 Health Technology Hazards for 2019. Customizing user-adjustable alarms to a patient’s respiratory parameters is an important risk-mitigation strategy for mechanically-ventilated individuals. In Ontario, the number of individuals requiring home ventilation has steadily increased over the last three decades. Home care ventilators are increasingly more complex and offer a variety of alarms. However, user-adjustable alarms must be appropriately set if they are to be effective in mitigating the risks of occlusions, leaks, and breathing circuit disconnections including those with high resistance at the site of the disconnection [1]. The Ontario Ventilator Equipment Pool (VEP), as part of a patient safety initiative, developed tools for the respiratory therapist to help guide the setting of safe and effective alarms on the model Phillips Trilogy200 ventilator, a model of ventilator used in the province of Ontario. The tool kit consisting of a pathway and accompanying guide provides the respiratory therapist with practical recommendations for initial alarm settings using simulation models to demonstrate “No Alarm” conditions. The tools will be presented along with case study practical applications., The current and previous clinical practice guidelines do not provide recommendations for or against the use of NIV in the treatment of AHRF. This presentation will describe the evidence (or lack of evidence) surrounding this issue. The presentation will describe some of the physiological differences between treatment options and the evidence to support device choices. Additionally, the current practice of delivering NIV to patients in AHRF will be described with comparisons between worldwide data and Canada using the LUNG SAFE database which includes over 4500 patients with AHRF by one of its authors., Each year more than 1000 Canadians undergo a spine injury. Spinal injuries can be the most physically and psychologically devastating injuries. BC has the highest per capita number of spinal cord injuries in Canada with most of these cases involving multi-systems. The VGH Spine Program is a world leader in SCI treatment and research. It is also BC’s only Spine-specific unit. Because there is only one hospital in BC that specializes in this population, RTs that come to VGH have to learn how to properly manage the complex respiratory needs of tracheostomized and ventilated patients with very little training. In addition, the VGH Spine Unit frequently has several ventilated patients under one RT at a time, all participating in a weaning process that is individualized to them. They also have very complex needs when it comes to other systems; therefore, effective communication with the interdisciplinary team is crucial to their rehabilitation, recovery, and quality of life. Using the working group model, I joined forces with some colleagues to seek to improve our practice and eventually bring all the disciplines together to create positive change in how these patients are cared for, and in turn, improve both patient experience and morale of staff. This is the story of our spine unit, what we’ve learned so far, and how we will use the working group to implement meaningful change., On April 23, 2018 in Toronto, ON, a rental van was deliberately driven onto the sidewalk near Yonge and Finch, killing ten people and injuring 15 individuals. Sunnybrook Health Sciences Centre’s Bayview Campus, approximately 10 km away from the scene of the tragedy, received ten of the injured, activating a Code Orange Minor. In collaboration with local EMS and Police Services, teams from Sunnybrook’s Tory Trauma Program and Operating Room (OR) triaged, assessed and treated multiple victims in what was perceived to be “organized chaos”. Staff Registered Respiratory Therapists (RRTs), Anesthesia Assistants (AAs) and a student respiratory therapist (RT) played vital roles within the interprofessional trauma team, providing immediate care for patients in the emergency department, OR and critical care unit. From the original trauma survey, RRTs and AAs were actively engaged in the care of these patients (i.e. intubation and ventilation, intravenous and arterial line insertion). Supportive care was provided during intra-hospital transports to imaging, interventional radiology, the operating room and intensive care areas. Lessons were learned organization-wide, which lead to the revamping of existing policies and the development of new procedures, including enhanced training opportunities (i.e. simulations, table top exercises). This ensures that Sunnybrook staff in collaboration with emergency services are prepared for any future mass casualty incidents. Experienced RRT staff, an RT student, and RT leadership will share their perspectives on the activities in the trauma room, the immediate and long-term impact on the mental health of staff and the vital importance of team debriefing following an incident of this magnitude.

Opioid-induced respiratory depression, commonly defined as a respiratory rate of less than 8 breaths per minute with a lowered blood oxygen saturation in the context of opioid administration, has been feared since the first days of opioid use in clinics. Mediated by the same μ- receptors responsible for opioid analgesia, this relatively low (0.5%) but highly preventable source of morbidity and mortality is always a risk. While the administration route of the opioid is not related to the incidence of respiratory depression, very potent, long-acting preparations and infusions put the patient at risk, as does the co-administration of certain drugs—especially sedatives or drugs having a significant impact on opioids metabolism through CYP450 or change in renal function. Relatively healthy patients are rarely victims of opioid respiratory depression. However, the “very” patients (very young, very old, very obese and very sick) and patients with sleep apnea, are more susceptible. They should be closely evaluated / monitored to ensure adequate pain control without respiratory depression. In the setting of opioid-induced respiratory depression, one could try non-pharmacological approaches, such as non-opioid pain control (pharmacological or other) and verbal/physical stimuli, while carefully monitoring the patient. Should opioid reversal be needed, naloxone should be given by any trained health professional, in small boluses of 40–100 mcg every 2 minutes, titrated to respiratory drive, not awakening nor pain control., Becoming a respiratory therapist was an easy decision. The fast-paced environment, high adrenaline situations and ever-changing technology is intensely attractive. Treating many patients every day, working against strict time constraints, and helping the healthcare team manage a disease is exciting. Our healthcare system is fantastic at managing disease. The problem is just that. “Disease management” is only one part of the patient’s care. Related to a unique personal experience, one teenage girl’s devastating diagnosis forced the staff at BC Children’s Hospital to open its eyes to the true meaning of holistic patient care. With many road blocks along the way, we were given no option but to make her life in hospital the most enjoyable we could. Taking her out to the mall for her craved poutine snack, to her high school graduation dance, and to the fabric store to buy her favorite patterns were just a few of the items we helped to check off her bucket list. Working together in a multidisciplinary team with the support of the patient, her family, and local community, we were able to help make her last days the most memorable and enjoyable days possible. After becoming such an integral part of this patient case, I now know what complete patient care truly means. Becoming a therapeutic partner with individuals, families, and communities, I, along with many of my respiratory therapist colleagues, were able to achieve the most rewarding experience of our careers to date., This retrospective review of personal clinical experience is aimed at helping SRTs entering their clinical year better understand what is expected of them and help with their transition from classroom to clinical. The transition can be difficult for some, and my goal is to try to bridge the gap between knowledge and practice. As a recent grad, I will share my experience throughout my 8-month clinical; the good, the bad, the ugly. I will talk about what to expect during different rotations, focus on a couple pathologies and ventilation strategies, and when and how to start looking for a job. I am by no means an expert, but hopefully some of my experiences will not only help the SRTs in their clinical year, but also give them hope and encouragement on their paths as they join this wonderful career., Throughout your classroom years as student, you will be warned about the challenges you may encounter in your clinical year. However, it is not until you are put in that trauma bay or moral dilemma that you are ultimately forced to face the inevitable. For some, an easy task—but for others, it’s difficult to cope or isolate themselves from overwhelming emotions. The expectation of what students may encounter clinically in terms of moral, ethical, and traumatic cases is touched upon in the classroom, but the reality of being put in that position is understated. For a young student to see a child at the bedside of their deceased father may hit closer to home than they would expect. Or for a student, who is also a mother, discontinuing care on a newborn may ultimately be too much to cope with. Or when a decision is made in a patient’s care plan that you disagree with—as a student, how do you stand up to or handle this ethical dilemma? The expectation versus reality of situations such as these are examples that students need to be enlightened about. This will allow them to be more prepared with tools and coping mechanisms when expectation becomes reality in their practicum year., Shift work and extended working hours is common practice amongst many healthcare professionals, including respiratory therapists (RTs). They respond around-the-clock to high stress situations, which can lead to major consequences if the worker is not getting an adequate amount of sleep. Working within an ever-changing schedule, such as the day/day/night/ night rotation that many RT’s work, can change a person’s natural circadian rhythm, leading to sleep deprivation. This, in turn, can lead to safety concerns for both the worker and their patients. Sleep deprivation also presents a major concern to both healthcare workers and their employers, resulting in millions of dollars per year in lost income, absenteeism, reduced productivity, compensation costs and attrition due to disability, death, or employee relocation. Safety of the worker and the patient is of utmost concern. The worker must be cognizant and alert to be able to fulfill their duties in a safe and effective manner. This can be statistically proven by the increase in needle stick injuries, which double when a worker is severely sleep deprived. There is an increase of 28% in general incidences over the course of a night shift, all attributed to sleep deprivation of healthcare workers. Education is an important key to bringing awareness of what sleep deprivation is, its effect on the human body, safety concerns, and ways to cope with working within a changing schedule in order to avoid some of the associated pitfalls., At the 2015 CSRT conference in Calgary, a question was posed to new grads during the student forum: “What do you feel like school hadn’t prepared you for?” All former students in the panel agreed that they felt the least prepared to deal with death. At the 2016 CSRT conference, I plan to assist new students as they prepare to deal with death, dying, and the families of those who have just passed through personal stories and experiences. My goal is to help students be better prepared for the transition from simulation, where a “patient” doesn’t make it, to a hospital setting where a live person is in front of you, rather than a plastic doll. Hopefully this talk can open up channels to allow students to share their experiences and gain support from others. This talk can hopefully empower students to feel more confident going into their clinical placement and provide them with a better understanding of what to expect in terms of end-of-life., Student preceptor relationships are a vital component to how a student respiratory therapist develops their clinical knowledge and skill set, interpersonal skills, attitude, and overall clinical competence. Conflicts within this relationship pertaining to communication, interpersonal conflict, and attitude can be a deterrent to the student and may affect their performance as a respiratory therapist. Currently, there is no evaluation of this relationship for respiratory therapy students across Canada. By conducting a national evaluation and comparison of this relationship via an online survey sent to students and preceptors, supported with a literature review on student preceptor relationships, problem areas will be identified with suggestions for improvement as to better future student preceptor relationships., Preceptoring is the basis of how the RT profession is propagated. It has been demonstrated in the literature that graduates integrate into their practice the knowledge, skills and attitudes role-modeled by their preceptor. As such, quality preceptoring is crucial to maintaining and increasing the importance of our profession in healthcare. A review of the literature also reveals the student-preceptor relationship is a key component to ensuring a quality graduate and the delivery of quality patient-care—both by the preceptor-student pair and in future graduate. In short, strong preceptors create strong students, who in turn create strong professionals in the workplace. So when is the best time to instill the core skills of preceptoring? As many RT students begin in the preceptor role shortly after graduation the SAIT RT program has targeted preceptor development to be introduced at this key moment—the final week of the RT program prior to graduation. In a novel approach combining small workshops with simulation, core preceptoring skills are developed. This presentation will outline how preceptor training was integrated into the SAIT RT program and how simulation was used as a key tool to solidify essential preceptoring skills. Student feedback on this experience will be used to explore the success of this approach., As students, one of the most uncomfortable moments on our first day is when we walk into a patient’s room and they acknowledge our presence. As strange as that may sound, until this moment we’ve spoken to nothing more than plastic – so a real, breathing human being can come as quite a shock. Of course, as students we know that the patients we care for are just like us, but until we step into that room, the whole picture hasn’t really come into focus. The goal of this presentation is to provide the educators a better understanding of that switch that students have to deal with continually throughout the clinical year. Each interaction, like each patient, can be very different than the last, and can cause a continuous shift in thinking and understanding of patient care. Educators need to understand that no matter how advanced a simulation lab is, until you place a real patient with real problems in front of a student they can never fully see it as you do. This presentation will cover a broad range of not only patients – from end-of-life to newborns – but also clinical experiences that I have found myself in as a student and felt overwhelmed in. The goals for the presentation are to not only help the educators run a more effective simulation, but to also educate the clinical RTs who are working one-on-one with students, on how to guide students through these new experiences., BACKGROUND: Increasingly, many health professions are exploring the use of peer learning models in clinical education. Peer learning can be defined as students learning from and with each other in both formal and informal ways. Traditionally, at University Health Network (UHN), respiratory therapy (RT) clinical education has been provided using a 1:1 student-to-preceptor ratio. However, with recent clinical placement demands exceeding supply, the UHN RT department has implemented a 2:1 student-to-preceptor model where a focus on peer learning becomes a key component of program success. The benefits of peer learning commonly discussed in the literature include an increased depth of knowledge gained from peer discussions, student leadership development, competence, critical thinking, teamwork, and communication skills.1 The shift towards facilitative student directed models have become apparent worldwide, particularly in the disciplines of occupational and physiotherapy.2 As the ways in which successful peer learning is understood and enabled may be different in different professions, a RT specific exploration of peer learning is a necessary step in the development of this model. OBJECTIVE: We aim to study how successful peer learning is defined by the preceptor and students in the RT clinical environment, in order to understand how it is enabled in practice based education. METHODS: A qualitative descriptive study using a demographic questionnaire and single episode semi-structured interviews with preceptors and students (estimated n=20) will be conducted during the 2015/16 RT student clinical year. EXPECTED RESULTS: Through a greater understanding of what successful peer learning is, the results of this study will assist us in developing a framework to facilitate successful peer learning in the RT clinical setting. IMPACT: This study will aid in the development of the 2:1 model in a way that is specific to the profession of RT although the strategies utilized may prove insightful for other professions., A new interface, the Neotech RAM Cannula, is now available to use as a non-invasive nasal interface for the neonatal population. The simplicity of its design does not require the use of head gears and other facial adjuncts to stabilize the interface, making it ideal in the prevention of pressure damage to the face and allowing for cranial development. However, a 20–40% leak must be present when using this interface to allow for exhalation, resulting in loss of set pressures when providing non-invasive respiratory support. Interestingly, there have been many centers trialing the Neotech RAM Cannula, with limited evidence supporting this therapy. The current study uses a 3D printed model of a nose to mimic the 20–40% leak when using the RAM cannula to provide CPAP and BiPhasic ventilation on a variety of neonatal ventilators. The results show that the premie-sized RAM cannula exhibits significant pressure loss, which is likely due to the tapering of the inner diameter of the opening of the prongs. The inner diameter of the tubing is 4.0 mm, while the inner diameter of the prongs is 3.5 mm, creating a significant loss of flow and thus generating a loss of pressure compounding the loss of pressure from the leak. The newborn-sized prong was consistently able to conserve most of the set pressure when a 20% leak was present when used in conjunction with the Servo-i and the Babylog VN500. The research team suspect that this may be due to the position of the pressure sensor within the ventilator circuit, or the algorithm that these companies decide to use to generate non-invasive ventilator pressures, or a combination of the two., In situ simulation allows teams to practice together in their genuine working environment while providing innovative opportunities to identify areas for quality improvement. Simulation education in general has gained a substantial positive presence in education literature over the last decade. While there is literature highlighting the benefits of in situ simulation over simulation laboratory education sessions, its adaption into curriculum and continuing education remains limited. In addition to traditional uses for in situ simulation (mainly education and team training), this workshop will focus on expanding the role of in situ simulation to identify latent safety hazards (LSTs) with the goal of ultimately providing better quality healthcare to the patients. By identifying the potential challenges and barriers and discussing the application of evidence-based practice tips for a successful in situ simulation program in their institutions, participants will have the opportunity to apply knowledge gained from this workshop into their own practice environment., The purpose of high fidelity simulation in respiratory therapy education is to help learners combine knowledge and practical skills gained in previous courses in preparation for real world clinical practice. The intent of this action research project was to investigate the effectiveness and objectiveness of learner evaluation methods used in the high fidelity simulation course offered as part of the curriculum of a three-year Respiratory Therapy advanced diploma program. A comprehensive literature review supported the theoretical framework of this project. A mixed-method approach to data collection was used. One paper-based questionnaire was completed by 47 participants to identify learner satisfaction with the simulation experience. An online questionnaire was completed by 16 participants to identify learner satisfaction with the evaluation methods and to gather suggestions for improvement. The qualitative component of the project involved two focus groups exploring 7 participants’ impressions of how evaluation practice in the course affected their learning process and competence in preparation for formal assessment. Data analysis found that the majority of participants were generally satisfied with the current evaluation process and considered the practice objective and effective in helping learners achieve their learning goals. Areas for improvement have been identified, and practice improvements such as team and communication skills assessment, student self-reflection assessment, and changing the grading system from a numerical grade system to a pass/fail system were suggested. The project offers suggestions for future research, including the development of a standard evaluation rubric in high fidelity simulation in respiratory therapy in Canada based on the national competency profile for entry to practice., Respiratory therapists are born leaders. In all areas of clinical and private practice, they are frequently forced to make critical decisions in team based and independent situations. The core of their learning and ongoing development is largely based in communication and critical thinking strategies. This presentation will review the essential competencies that enable respiratory therapists to be leaders beyond their realm of clinical proficiency. It will discuss the attitudes, skills and knowledge that are required to move clinicians into leadership positions within and outside of healthcare. Using case study reviews from respiratory therapists who have evolved their careers in varied pathways, traits and competencies will be revealed to assist emerging leaders in considering their leadership development., In healthcare, there are many important aspects that play a part in the quality of care a patient receives. As our population continues to diversify, we are more frequently providing care for patients that may not speak English as a first language, or at all. Identified as language barriers, this presentation will review the challenges that we currently face in providing quality care to these groups and the impacts it has on both the healthcare system and the patient. Historically, those who do not speak the language of majority are found to be of poorer health. A review of various literature will discuss the issues that exist within the healthcare system and the influence it has on patients, communities and populations. The gaps and barriers in which research wasn’t able to identify the discrepancies between these groups will be identified. As a respiratory therapist, the inability to communicate and understand a patient can significantly impact the course of treatment, investigations and, most importantly, the quality of care. There are many projects and agencies that tackle this issue directly, and an introduction will provide a resource to clinicians working directly with patients and language barriers., In the spring of 2013, Ebola struck West Africa for the first time. Within a few months, the outbreak was spiralling out of control. I travelled to Sierra Leone to work in an Ebola treatment centre run by Save the Children. In this talk, we will look at the history of this dangerous virus, the social and political factors that played a part in the severity of this particular outbreak, how I became involved, the inner workings of the hospital, and some stories from my personal experiences and those of my colleagues while fighting this disease on the front lines. For anyone who has considered relief work in a low resource environment, this will be an inside look at what it’s really like to put yourself in harm’s way in a foreign land., Transitioning from a student to a professional role can be challenging and stressful without a standardized orientation and mentorship process. Fraser Health Authority became aware of these challenges and developed a mentorship process to overcome these issues. This presentation will outline how Fraser Health Authority has implemented the mentorship process for new hires, along with the specific tools used to help orientate staff in the workplace. Implementation of the mentorship process will be discussed, including an outline of the process itself, which consists of mentee/mentor roles and responsibilities, different learning and teaching styles, and stages of mentorship. We will discuss the challenges that the new hires and staff faced prior to implementation, followed by the differences after a standardized mentorship process was initiated. Specific examples of challenges and successes before and after the mentorship process was implemented will be discussed. The mentorship process has helped new hires in Fraser Health Authority gain experience, build confidence, and improve competency, which ultimately allows new hires to optimize successful entry into their role in order to provide exceptional patient care., Building strong engagement and motivation while working towards a shared goal are some of the foundational traits on which the gaming industry is built. Gamification is the use of game elements and design in non-gaming contexts, and is rapidly spreading internationally as an exciting way to change established patterns of behaviour. This session is designed to provide participants with an understanding of how motivational theory and game design can engage patients, families, and those working within the health system to improve quality of care. Participants will be able to articulate the rationale for using gamification in a health improvement context; consider strategies to shift behaviour using extrinsic and intrinsic motivators; and explain the basic elements of games and how they can be applied in health improvement initiatives., The build of a new 1.6 million square foot hospital in Oakville, Ontario, from the ground up was an undertaking of magnificent proportions. It brought together a myriad of individuals from many fields, each with a unique and important contribution to the project. Within the healthcare organization, an interdisciplinary approach was required to identify specific hospital requirements for a state-of-the-art facility while providing vision and clarity to new and transferable processes. Externally, collaboration with builders, architects and consultants was essential for the design development process to ensure that patient care was nothing less than perfect once the building was fully functional. This presentation will demonstrate how respiratory therapists (RTs) played an integral role in the design and decision-making processes involved in the building and opening of a new facility. It will highlight the stages involved in this ambitious and massive project, along with the successes and challenges from an RT perspective. It will demonstrate how the direct appointment of RTs into redevelopment specialist and operational readiness roles played a major part in the successful transition to the new Oakville Hospital and future redevelopment projects. Additionally, there will be emphasis on how both the clinical expertise and leadership skills of RTs have contributed to the acquisition of nontraditional RT roles at Halton Healthcare., There is a growing interest in respiratory therapy professionals who wish to give back globally and make strategic and sustainable contributions to improving respiratory health by sharing expert skills, knowledge and experience. Respiratory Therapists Without Borders (RTWB) exists to improve respiratory health through education advancement of local healthcare providers worldwide. RTWB balances on 3 pillars: Healthcare Education Partners (HEPs) that drive the existence of RTWB by identifying respiratory education gaps worldwide; the Professional Network (PN), which is a conglomerate of respiratory care professionals with a unified passion to advance respiratory health; and deployment teams that are formed to support the HEP with on-site training. Collectively, these 3 pillars enable RTWB to fill specific gaps in respiratory education for individual HEPs, enhance the professional network by sharing knowledge and experiences, and provide volunteers with enriching and impactful experiences abroad. The developing HEP network consists of 11 sites across 3 continents from reputed teaching hospitals to research groups. The growing PN is 215 volunteers strong from both public and private sectors, bringing bedside and managerial experience from around the globe to meet HEP needs. Since Canadian charity registration (July 2014), there have been 7 deployments. This presentation will outline the projects undertaken in each deployment, highlighting the successes achieved., Volumetric capnography (VCap) is a powerful monitoring tool that can help support clinical decision making in the intensive care unit. The technology has been available for decades; however, difficulties in understanding and interpreting the measured values have led to limited use in some intensive care units. VCap is the graphical representation of the CO2 concentration (Y-axis) against the expired tidal volume (X-axis), and can be used to calculate dead space. VCap also provides information about CO2 production, its transport by systemic circulation, its diffusion into the lungs, and its elimination via alveolar ventilation. A short review of capnography will be provided, as well as a thorough explanation of how VCap measures the exhaled volume of CO2. A review of the current literature will be presented to help clinicians understand the clinical application of VCap and different ways it can be used in the intensive care unit (e.g., ARDS mortality, PEEP titration, dead space measurements, sepsis, etc.). Lastly, a case study will be presented to help further concrete the clinicians understanding and interpretation of the VCap values. With advances in VCap technology and an improved physiological understanding, we will hopefully see its increased use in intensive care units throughout the country., Sepsis is a life threatening medical condition characterized by a widespread, overwhelming inflammatory process that is triggered by infection. Each year there are more deaths associated with sepsis worldwide than myocardial infarction and any one type of cancer. Unlike many other life threatening conditions, sepsis is not selective—it occurs in young, healthy individuals as well as in the elderly. Despite advances in critical care medicine, this condition continues to have a huge financial impact on our healthcare system. What does this have to do with respiratory therapy? Of the clinical conditions associated with Acute Respiratory Distress Syndrome (ARDS), sepsis is the leading cause. Furthermore, mortality in sepsis is dependent on patients receiving appropriate treatment within hours of diagnosis. As such, it is imperative that healthcare professionals be able to recognize the signs and symptoms of sepsis. In acute and critical care areas, respiratory therapists are often consulted at the first sign of patient deterioration. Therefore, our profession is uniquely positioned to advocate for the early recognition and management of sepsis. This presentation will equip respiratory therapists with an understanding of the latest evidence based guidelines on the diagnosis and treatment of one of the leading causes of death worldwide., Risk stratification of an adult patient who requires emergency airway management is crucial to patient survival. Categorizing the patient’s clinical state allows the emergency provider to prepare and initiate treatment for definitive airway security and management. The emergency provider must consider the patient’s anatomical challenges, establish a strategy for proper positioning, and utilize accessible equipment in order to maximize this process. This presentation will review pre-oxygenation and peri-intubation oxygenation techniques for the adult patient. The goal of the emergency provider is to decrease a sick patient’s risk of hypoxemia. Critical desaturation will put a patient at risk for hemodynamic instability and possibly, death. Once a patient’s oxygen saturation reaches the end of the oxyhemoglobin dissociation curve’s “plateau,” the risk of precipitous desaturation and compromise is high. It is probable that a patient in respiratory distress will progress to hypoventilation and have periods of apnea. The need and intention to place a definitive airway in a critical patient during RSI or DSI will contribute to further hypoventilation and apnea. Pre-oxygenation and peri-intubation oxygenation will promote “safe apnea” during this period of critical care, thus preventing catastrophic desaturation., BACKGROUND: The use of chlorohexidine as an antiseptic cleaning agent has been proven in wound care, invasive procedures and dental use. Thus, the use of chlorohexidine as an antiseptic in tracheostomy care may decrease the amount of infection and promote tissue healing in early tracheostomies and developed stoma sites. OBECTIVE: To assess the application of chlorohexidine in tracheostomy care. METHODS: A literature review of research on the application of chlorohexidine to tracheostomies showed no harmful outcomes. Chlorohexidine showed the ability to kill gram positive, gram negative bacteria and some strains of MRSA. The use of chlorohexidine is now being trialed and compared to standard tracheostomy care with normal saline. Therapists will judge how they like it, and a retrospective chart review will be performed. The ongoing results will be presented at the Canadian Society of Respiratory Therapy. CONCLUSION: Currently, the only research available for chlorohexidine-based tracheostomy care concerns insertion. Based on the current literature about using chlorohexidine-based solutions as the standard in ostomy and wound care, one can infer the benefits for tracheostomy care; however, further research is still required for the routine use of chlorohexidine. In summary, the practical application of chlorohexidine in tracheostomy care is safe, efficient, and cost effective., The continuum of care for medically fragile children, many of whom are technology dependent, requires the careful allocation of resources, respiratory supplies, equipment and/or oxygen. Balancing clinical care and the stability of a pediatric patient with quality of life opportunities is important. However, this brings tremendous responsibility and accountability to the respiratory therapists (RRTs) involved with this unique population. RRTs demonstrate advanced leadership in preparing for these transitions to the community to ensure that the children are not only stable when discharged from the hospital, but are able to be safely cared for by their caregivers and community care providers at home. This presentation showcases the diligence and extraordinary efforts of RRTs from an acute care hospital (SickKids) and from a long-term care rehabilitation hospital (Holland Bloorview Kids Rehabilitation Hospital), focusing on care pathways: models of care delivery that are geared towards rehabilitation and habilitation for the final discharge at home. Approaches that combine a model of family centered care, cultural sensitivity, use of interpreters and creative strategies will be illustrated. Case studies of children and their caregivers are presented to highlight the methods and approaches to overcoming the challenges faced when transitioning these patients into the community., In 2013, the Alberta Children’s Hospital (ACH) in Calgary identified improving care coordination for children with complex airway needs (i.e., tracheostomies with or without mechanical ventilation) as a site-wide priority. A quality improvement project was initiated to enhance service integration across the continuum of care, from PICU to community care. Gaps and challenges identified within the current system included: no integrated education curriculum or process to support families caring for children with complex airway needs in the community; acute care and hospice/respite care staff with limited awareness of community care standards and a lack of chronic ventilation expertise; and challenges in staff maintaining expertise given low patient volumes. To address these gaps, a new role was created to bring home respiratory and ventilation management and education expertise into the hospital and hospice/respite environments. The Trach Simulation Coordinator is responsible for leading development of a best practice educational suite for tracheostomy care and chronic home ventilation, tailored to each child and the caregivers involved in their care. Families will be supported by education, simulation, and navigation throughout the in-patient process so they are prepared to care for their child in their home and community. This role will act as the resource and support for both families and staff to address the unique airway needs of these complex children, so they can get home quickly, stay home with the services and supports they need, and be supported when they require hospital or hospice/respite readmission., This narrative reviews how the knowledge, skills and judgment of the respiratory therapist can be applied to the management of neonatal emergencies. The mnemonic “THE MISFITS” represents Trauma, Heart Disease, Endocrine, Metabolic, Inborn Errors, Sepsis, Formula Mishaps, Intestinal Catastrophes, Toxins, and Seizures. These categories represent broad differentials and a systematic approach to the recognition, emergency stabilization, and management of the common newborn emergencies.1 In each of these categories, there are areas where the core knowledge, skills and judgment of the respiratory therapist can be applied. This includes, but is not limited to, physical assessments, interpretation of diagnostic testing, and performance of invasive procedures that can be applied to the stabilization and management and reduce morbidity and mortality. Similarly, it is shown how using “THE MISFITS” mnemonic can be applied to undifferentiated case studies to determine possible differentials., A 20-patient NICU pilot study was completed, comparing CPAP to noninvasive NAVA in infants 28–32 GA with RDS. The objective of the pilot study was to determine the adherence to the protocol. Infants with RDS are successfully being supported with CPAP. Non-invasive NAVA might present a strategy that improves outcomes with both synchrony and respiratory offloading compared to CPAP. Clinical outcomes were similar between groups and there were no adverse events. Adherence to the protocol was high, indicating that an RCT can be developed to assess if noninvasive NAVA can be used as a primary mode of respiratory support for infants 28–32 weeks GA. As clinicians well-known for the ability to respond and adapt to rapid changes in healthcare and technology, RTs are positioned well to critically examine and challenge EBUS assist practices. We believe we can translate this research to advance this area of practice in respiratory therapy., Severe COPD is associated with chronic dyspnea, reduced functional capacity and quality of life, frequent hospitalizations and high mortality. A subset of patients will develop chronic hypercapneic respiratory failure. Non-Invasive Ventilation (NIV) has been well-established as a beneficial intervention in the acute setting in severe hypercapneic COPD exacerbations. However, data demonstrating the clinical benefit of long-term nocturnal home NIV in COPD have been less convincing, and often conflicting. Despite this lack of evidence, chronic NIV use is high in some parts of the world. New evidence suggests that NIV may confer a mortality benefit in chronically hypercapneic patients. Controversy remains regarding issues such as use of “high-intensity” NIV, physiologic goals of NIV, patient selection, and timing of initiation., The evolution of home mechanical ventilation over the last couple of decades has seen clinical practice change to meet the complex and unique respiratory needs of this patient population. There is an increased demand for home ventilation due to available technologies that support an expanding number of diagnoses. New and emerging specialized services and technologies for supporting the ventilator-assisted individual (VAI) at home will be discussed. An overview of two distinct provincial programs, Quebec’s PNAVD and Ontario’s Ventilator Equipment Pool (VEP) will be presented, with an emphasis on how each program is rising to meet the needs of VAIs, their caregivers, and clinicians. The participants will also have an opportunity to hear first-hand testimony from a ventilator-assisted patient., Observational research is an alternative to the gold standard of randomized controlled trials within healthcare research, and its application to healthcare issue are warranted when interventional studies are unethical or impractical. While frequentist methods of analysis are well-suited to interventional medicine, their application to subjectively-collected observational data have been brought into question. Exploring alternative forms of methodology and analysis open avenues for the researcher to derive more appropriate inference from observational studies. Bayesian analysis has been presented as a more flexible method of analysis in modeling subjective data by incorporating prior information. Additionally, Respondent Driven Sampling (RDS) has been offered as a means of sampling and analyzing hard-to-reach populations in an unbiased manner. Using data collected from two large observational studies in British Columbia, the presenter will provide practical examples of the application of Bayesian analysis in comparison to frequentist analysis in the context of subjective data, as well as RDS methodology and analysis to derive unbiased estimation from a non-probability sample. With the acceptance and application of these methods and analysis to observational data, the presenter hopes respiratory therapists may expand their contribution to evidence-based healthcare research., Endobronchial ultrasound (EBUS) is a minimally invasive bronchoscopic procedure used for the diagnosis of lung lesions. When paired with transbronchial needle aspiration of the mediastinal lymph nodes, EBUS allows for the detection and staging of lung cancer. Although a relatively new procedure, it is now performed by bronchoscopists across Canada, generally assisted by nurses and respiratory therapists (RTs). EBUS is a largely undocumented area of practice for RTs in Canada. Without formal training programs or recommendations for competency, RTs assisting with EBUS are relying on their knowledge and skills in acute airway management and conventional bronchoscopy to develop this role. Providence Health Care’s St. Paul’s Hospital in Vancouver has been performing the two types of EBUS, linear and radial, for over six years. As RTs working in the area, we have been setting our own practice standards and self-monitoring for quality. With the number of EBUS cases performed rising annually, we have been challenged to routinely evaluate our processes and alter our practices to continue providing safe patient care. Examples of quality improvement initiatives implemented at our site include a pre-procedure checklist, enhanced patient monitoring with the use of end-tidal CO2, and changes to scheduling and staffing to improve patient flow. Owing to the specialized nature of this role, seeking out the experiences of other RTs assisting with EBUS procedures was recognized as an important way to evaluate processes and improve quality of care. We designed a web-based questionnaire querying the general processes, staffing models, and training procedures occurring at the other eight EBUS sites across British Columbia. We will be sharing the responses to provide an exciting first snapshot of RT practice in EBUS assist. We further intend to use these shared experiences to open a dialogue on standardizing practice in this new and specialized field of practice., Anesthesia Assistants performing procedural sedation and analgesia in the Cardiac Catherization Lab can be very fulfilling and, at times, very challenging. Patients present with interesting medical histories and current cardiac status; decisions regarding minimal sedation vs deeper sedation have to be made. Length and type of procedure vary, and surprises could arise at any time. In this presentation, the learner will review a wide variety of information on cases which involve pacemakers, ICD’s, EP mapping and Ablation therapies, as well as transesophageal echo (TEE) anatomy and pathophysiology., We have all been there: a sudden snip, a post-partum hemorrhage, an ER trauma, a ruptured AAA. All of a sudden you are scrambling to cope with massive blood loss in an environment of escalating panic; tension is rising, vitals are falling, alarms are ringing. Though everyone wants to help, no one is quite sure of his or her role, or what exactly needs to be done. In this confusion, precious life-saving seconds are wasted, and the likelihood of survival decreases. At Halton Healthcare, we recognize that as a growing community hospital, we are caring for an ever-expanding patient population, and are offering healthcare services in larger settings than we ever have before. Our introduction of a vascular surgical program, as well as an expanding labour and delivery program, made us realize we needed to implement a massive transfusion protocol to best avoid the scenario described above. This presentation will provide the basics on massive blood loss, and what is meant by a massive transfusion protocol. It will identify the key staff members necessary to carry out such a protocol, and highlight in particular the role of the Anesthesia Assistant. Lastly, it will discuss how the protocol went from concept to reality within Halton Health Services, and hopefully will inspire those listeners who do not have such a protocol to take the lead in their own institutions to make theirs a reality as well., It has been well established that an anesthesia care team (ACT) provides safer, more effective and more efficient care than an anesthesiologist working alone. Although the incidence of direct anesthesia mortality in uncomplicated cases is low (estimated to be 1/200,000) the incidence increases with the complexity of the patient or the complexity of the procedure. An ACT directed by an anesthesiologist may consist of physician residents, fellows or non-physician certified nurse anesthetists or technicians. In Canada, the Canadian Anesthesiologists Society (CAS) has endorsed the Anesthesiologist/Technician model. The traditional role of the operating room respiratory therapist (RRT) included providing technical support to the anesthesiologist for the proper use and maintenance of the anesthetic gas machine. The role of the Anesthesia Assistant (AA) is relatively new, and although there is variation in scope of practice and regulations between provinces, the most common roles include providing technical support to the Anesthesiologist for complex anesthesia equipment; providing airway management assistance; and monitoring the patient’s hemodynamic status, blood, fluid and pharmacological therapy. The AA provides physiologic surveillance of the stable patient under general anesthesia, regional anesthesia and for procedural sedation. The role of the AA is evolving and expanding—training requirements are becoming more rigorous, and there is demand for specialty credentialing. As patient care becomes increasingly complex, the demand for AA will continue to increase., Anesthesia Assistants see a wide variety of cases every day. Thoracic surgery cases usually present with interesting preoperative diagnostic workup and testing, which we don’t get to see 10 minutes before the patient enters the OR. In this presentation, the learner will go back in time and review how this patient got to us and how our actions could have caused some major issues. When working in the OR and ICU, we hopefully all realize that the simple actions we perform may have detrimental consequences. A review of other iatrogenic cases will be also be discussed., CSRT’s Blueprint of the Profession demonstrated that certification of advanced formalized education is a priority of respiratory therapists. As such, Anesthesia Assistants are respiratory therapists, nurses and other appropriately qualified healthcare professionals that enter an area of practice known as Anesthesia Assistant after completing a recognized educational program. This session is designed to provide participants with an understanding of why the Anesthesia Assistant Certification Workgroup was formed, who are the working group members, and what unique perspective they bring to the working group. There will also be discussion on the implementation of national standards for anesthesia assistants including the AA Educational Framework, the validation of the competency framework, the implementation of a national exam and a process for the accreditation of schools that offer the AA program., La présentation fera une révision du transport des gaz respiratoires dans l’organisme ainsi qu’une description de certains mécanismes physiologiques présents lors de l’administration d’oxygène chez une clientèle MPOC (ex.: l’altération du rapport ventilation/perfusion, l’effet Haldane, la diminution de la drive respiratoire). Ces mécanismes peuvent entraîner une hypercapnie et accentuer la détérioration clinique d’un patient.

A national survey was conducted to describe the coverage and characteristics of infection prevention and control (IC) programmes in Italy and to evaluate progress during recent years. All regions, with one small exception, participated and the response rate was 88%. Nearly all 278 respondent public health trusts reported having an IC committee, 80% of the 615 respondent hospitals to have instituted an IC team, and 79% to have an IC nurse. However, when the presence of truly operating IC bodies was considered, the pattern was different: only 27% of IC teams met at least monthly, and variation by region was extremely large [coefficient of variation (CV): 1.06]. The IC programme characteristics with the greatest variation by region included: availability of qualified nurses and IC doctors (CV: 1.55 and 1.39 respectively); integration of IC activities and clinical risk management (CV: 1.05); IC programmes also involving community services (CV: 0.98); training of personnel at induction (CV: 0.82); and availability of written policies for the control of multidrug-resistant organisms (CV: 1.08). A relevant and statistically significant North-South gradient showed Southern Regions averaging 23 points less than Northern Regions on the IC score. Compared with a similar survey conducted in 2000, the distribution of several activities by region had improved significantly. Despite the noteworthy improvement observed over time, the situation in Italy is still unsatisfactory, due to significant variation in the development of IC organisations and initiatives by region and by type of hospital.

Programmes surveying surgical site infection (SSI) have been implemented throughout the world and are associated with a reduction in SSI rates. We report data on non-prosthetic surgery from the Italian SSI surveillance programme for the period 2009 to 2011. Participation in the programme was voluntary. We evaluated the occurrence of SSI, based on protocols from the European Centre for Disease Prevention and Control, within 30 days of surgery. Demographic data, risk factors, type of surgery and presence of SSI were recorded. The National Coordinating Centre analysed the pooled data. On 355 surgical wards 60,460 operations were recorded, with the number of surveyed intervention doubling over the study period. SSI was observed in 1,628 cases (2,6%) and 60% of SSI were diagnosed through 30-days post discharge surveillance. Operations performed in hospitals with at least two years of surveillance showed a 29% lower risk of SSI. Longer intervention duration, American Society of Anesthesiologists’ (ASA) score of at least three, and pre-surgery hospital stay of at least two days were associated with increased risk of SSI, while videoscopic procedures had reduced SSI rates. Implementation of a national surveillance programme was helpful in reducing SSI rates and should be prioritised in all healthcare systems.

Background Italy had intermediate-level endemicity for hepatitis B virus (HBV) infection in the 1970s and 1980s. In 1991, vaccination of infants and adolescents became mandatory. We report the impact of universal vaccination 14 years after its beginning. Methods We performed a case-control study within a population-based surveillance for acute viral hepatitis. The incidence of acute hepatitis B (AHB) was estimated for the time since 1991, and the association between AHB and the considered risk factors was analyzed for the period 2001-2005. Results The incidence of AHB progressively decreased from 1991 to 2005, mainly for persons in the age groups targeted by the universal vaccination campaign: there was a 24-fold and 50-fold decrease in the 15-24-year and 0-14-year age groups, respectively; for the > or =25-year age group, the incidence halved. Owing to the persons' ages, approximately 3% of total AHB cases should have been the target of vaccination campaign. In 2004-2005, foreigners accounted for 14% of total cases and for 57% of persons who should have been targets for vaccination. Missed opportunities for immunization were documented for approximately 50% of patients with AHB who reported cohabitation with HBV carriers and for 70% of those who reported injection drug use. The strongest associations with AHB were found for blood transfusion (adjusted odds ratio [OR(adj)], 8.4; 95% confidence interval [CI], 2.7-26), cohabitation with HBV carriers (OR(adj), 5.3; 95% CI, 3.6-7.7), injection drug use (OR(adj), 3.8; 95% CI, 2.5-5.8), and unsafe sexual practices (OR(adj), 2.8; 95% CI, 1.9-4.2). Conclusion Universal vaccination has contributed to a decreasing AHB incidence in Italy, especially by reducing the risk of infection among persons aged 15-24 years. Most infections occur in persons aged > or =25 years in association with injection drug use, unsafe sexual activity, percutaneous treatment, and iatrogenic exposure. Improvement of vaccine coverage in high-risk groups and adherence to infection control measures during surgery and percutaneous treatment are needed. The high risk still associated with blood transfusion needs to be further investigated, with consideration of occult HBV infection in blood donors. The potential spread of HBV infection from the immigrant population deserves adequate health policy prevention programs.

Visceral leishmaniasis (VL) is a public health problem in most countries bordering the Mediterranean sea. The disease has been found in central and southern Italy, Sicily, Sardinia; some pockets are present in Liguria. Dogs are the reservoirs and the vectors are some species of sandfly (Phlebotomus species). The incubation period is usually between 2 and 8 months; children and adults may become infected; lethality may be high and depends upon a correct diagnosis and treatment. The diagnosis should be suspected on the basis of the epidemiological data and clinical picture and confirmed by the detection of specific antibodies by appropriate techniques. Leishmaniasis can be detected in splenic or bone marrow aspirates. Patients with HIV infection and VL may lack specific antibodies; parasitological diagnosis is mandatory for these patients. Antimonials are the classic therapeutic agents for VL. Recently liposomal amphotericin B (Ambisome) has been successfully used, with negligible toxicity.

Italy has participated in the Health Behaviour in School-aged Children (HBSC) study since 2000. These surveys collect data every four years on the well-being and health behaviour of boys and girls aged 11, 13 and 15. Until 2007, the coordination group of the University of Turin, Siena and Padua directly sent the questionnaires to each sampled school to collect the data. The sample of about 4500 students was nationally representative. In 2008 the HBSC became part of the project "Surveys on behavioral risks in children aged 6-17 years", coordinated by the National Institute of Health (ISS) and promoted by the Ministry of Health, in collaboration with the Ministry of Education, University and Research. For the first time, in 2010, the survey was conducted by health workers in collaboration with teachers in all regions with a representative sample, not just at the national level, but also at regional level. In the 2,504 sampled schools, 77,113 students (25,079 eleven-year-old, 26,048 thirteen-year-old and 25,986 fifteen-year-old) completed an anonymous questionnaire. Knowledge of the health-related behaviour of school-aged adolescents may help monitoring and enable policies for young people to be formulated and implemented.