Vented Patients in Rural Communities

Case Study

Problem: Managing vented patients in rural communities

For rural hospitals, the COVID-19 pandemic stretched respiratory therapy programs to their limit. Typically, patients requiring mechanical ventilation were transferred to larger hospitals with a greater capacity for specialty care. However, when the referral centers were overburdened with COVID-19 surges and lacked critical care beds, smaller hospitals cared for patients they would normally transfer.

Like many other rural hospitals, one client saw an increasing number of patients with severe COVID-19 symptoms requiring advanced respiratory support. This included patients that required high flow oxygen, non-invasive ventilation, and intubation. They needed a cost-effective and financially viable solution to manage complex respiratory patients in a holding pattern, waiting to be transferred to an outside larger hospital.

Case Background

A 76-year-old patient presenting to a critical access hospital with pneumonia due to COVID-19 initially required minimal oxygen of 2-3 liters per minute on nasal cannula. This soon escalated to requiring intubation over the course of a three-day inpatient stay before being transferred to a tertiary hospital. During this time, the patient required active airway management.
  • Patient’s oxygen needs steadily increased over several days.
  • SpO2 continued to decline, and the work of breathing increased on day 3 of hospital stay
  • Patient was unable to prone due to recent elbow surgery
  • Chest X-ray showed hypoinflation and multifocal airspace opacities
By working closely with the onsite clinicians, Beam’s Tele-Respiratory Therapist assessed and assisted with care for this patient, from requiring a nasal cannula to requiring intubation. The patient was placed on high flow oxygen in a timely manner and was proactively monitored as the demands continued to increase despite high flow oxygen.

As the patient continued to decline, the patient was placed on non-invasive ventilation (NIV) and was later intubated to meet the respiratory demands. A respiratory therapist was present via telemedicine throughout the intubation and post intubation, ensuring that settings were optimized for the patient and that vital steps were taken throughout the process, such as pre-intubation equipment checks and post-intubation endotracheal tube placement confirmation.

These measures ensured that the patient remained in stable condition during the holding period for transfer to a tertiary hospital.

Summary

The COVID-19 pandemic overwhelmed many rural respiratory therapy programs. With an influx of patients requiring advanced respiratory support, hospitals were forced to care for patients that they would normally transfer, despite a lack of resources. One rural hospital was feeling the strain of COVID-19 surges and noticed a need for advanced respiratory support for COVID-19 patients in a holding pattern.


After looking for a financially viable solution, they partnered with Beam Tele-Respiratory to provide the care that their patients needed. Beam RT worked closely with onsite clinicians to assist with everything from pre-intubation equipment checks to post-intubation endotracheal tube placement.

As a result, facilities can now provide specialized care locally with Beam Tele-Respiratory. This reduces healthcare barriers for patients while advancing critical care in rural communities, allowing them to receive outstanding high quality care closer to home.



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