Dr. Dennis E. Doherty, FCCP

NAMDRC is bringing together representatives of key medical societies, including CHEST, ATS, AARC, SCCM, AACN, SHM (hospitalists), PPAHS (patient safety), and ACEP (emergency physicians) to address respiratory compromise, that cascade of events that moves from respiratory insufficiency to respiratory failure to respiratory arrest. Recognizing that respiratory compromise occurs in various settings, the conference, Feb 26-27 in Orlando, Florida, will focus on the hospital setting.

In addition to society representatives, the NAMDRC leadership, in consultation with recognized experts, has also invited several key opinion leaders to participate, including physicians, respiratory therapists, and nurses.

There are several challenges facing the participants, perhaps paramount is to define the concept of “respiratory compromise.” Some of have signaled, “I know it when I see it,” but the expectation is to formulate a specific clinical definition of the respiratory deterioration, and devise a recognition pathway that can easily be used in the hospital setting to identify patients earlier in the course of this cascade.

How to identify high risk patients is critical to the discussion, because it is generally believed that this is where resources need to be focused, both from a personnel and monitoring perspective. Can consensus be drawn to determine which patient characteristics can reliably classify that patient into a high risk for respiratory compromise, and, if so, those characteristics should be delineated. The corollary challenge is to identify the low risk patients so that inappropriate resources are not focused where such efforts might not be necessary.

Individual hospital policies are integral to this issue, as the relative value of rapid response teams appears to vary greatly. Add to the equation a recent Wall Street Journal article (http://online.wsj.com/search/term.html?KEYWORDS=Heart%20attack) that highlighted the success of managing heart attacks outside the hospital but the notable challenges of managing those events when they occur within the inpatient population.

Another key challenge facing roundtable participants will be to focus their discussions on what clinical parameters should be monitored and which, if any, should be put on the back burner. There is a relatively wide variation of views regarding what should be monitored, what thresholds are problematic and indicative of a declining patient, and what actions need to be taken, and how swiftly, to abate the downward cascade of respiratory compromise. A related challenge facing participants is, “should the industry be moving toward refinement of their monitoring technologies to give physicians and the health-care team more valuable and more timely information? Are we monitoring the right parameters, or are we monitoring what the technology allows us to monitor? Are there gaps that can be addressed?”

While no one is confident of the specific direction these discussions will take, it is likely that not only will the proceedings be documented for submission for publication, but it may very well lead to other conferences that focus on respiratory compromise in other settings. Both the skilled nursing facility and long-term acute care hospital settings provide care for a spectrum of pulmonary/ventilator patients, and the characteristics of their potential cascade of deterioration may or may not be the same as in an acute care hospital. The challenges are similar, but solutions may be different—a subject for further discussion.

This conference is just one example of NAMDRC’s approach to a range of pulmonary-related clinical issues. While NAMDRC’s broad mission is to “improve access to quality care for patients with respiratory disease by removing regulatory and legislative barriers to appropriate treatment,” the roundtable does fit into the mission because of growing concerns that we are facing challenges that are solvable if we take the initiative to address solutions to these challenges.

Another very broad challenge facing NAMDRC is its belief that the growing area of home mechanical ventilation is being shaped by archaic and outdated legislation and regulation. In fact, in a discussion with Marilyn Tavenner, CMS Administrator (and critical care nurse by training) last August, she conceded that the laws and regulations have not kept pace with innovations as basic as noninvasive mechanical ventilation. The idea that mechanical ventilation involves intubation or tracheostomy is universally recognized as archaic. As archaic is the concept that, by definition, ending mechanical ventilation leads to imminent death. While that may have reflected technologies of the 1980s and early 1990s, it is not reflective of today’s standards of care. Amending the existing laws and regulations in this area may become a high priority for NAMDRC over the next few years.

For membership information, visit the NAMDRC website at www.namdrc.org or call 703/752-4359.

NAMDRC is bringing together representatives of key medical societies, including CHEST, ATS, AARC, SCCM, AACN, SHM (hospitalists), PPAHS (patient safety), and ACEP (emergency physicians) to address respiratory compromise, that cascade of events that moves from respiratory insufficiency to respiratory failure to respiratory arrest. Recognizing that respiratory compromise occurs in various settings, the conference, Feb 26-27 in Orlando, Florida, will focus on the hospital setting.

In addition to society representatives, the NAMDRC leadership, in consultation with recognized experts, has also invited several key opinion leaders to participate, including physicians, respiratory therapists, and nurses.

There are several challenges facing the participants, perhaps paramount is to define the concept of “respiratory compromise.” Some of have signaled, “I know it when I see it,” but the expectation is to formulate a specific clinical definition of the respiratory deterioration, and devise a recognition pathway that can easily be used in the hospital setting to identify patients earlier in the course of this cascade.

How to identify high risk patients is critical to the discussion, because it is generally believed that this is where resources need to be focused, both from a personnel and monitoring perspective. Can consensus be drawn to determine which patient characteristics can reliably classify that patient into a high risk for respiratory compromise, and, if so, those characteristics should be delineated. The corollary challenge is to identify the low risk patients so that inappropriate resources are not focused where such efforts might not be necessary.

Individual hospital policies are integral to this issue, as the relative value of rapid response teams appears to vary greatly. Add to the equation a recent Wall Street Journal article (http://online.wsj.com/search/term.html?KEYWORDS=Heart%20attack) that highlighted the success of managing heart attacks outside the hospital but the notable challenges of managing those events when they occur within the inpatient population.

Another key challenge facing roundtable participants will be to focus their discussions on what clinical parameters should be monitored and which, if any, should be put on the back burner. There is a relatively wide variation of views regarding what should be monitored, what thresholds are problematic and indicative of a declining patient, and what actions need to be taken, and how swiftly, to abate the downward cascade of respiratory compromise. A related challenge facing participants is, “should the industry be moving toward refinement of their monitoring technologies to give physicians and the health-care team more valuable and more timely information? Are we monitoring the right parameters, or are we monitoring what the technology allows us to monitor? Are there gaps that can be addressed?”

While no one is confident of the specific direction these discussions will take, it is likely that not only will the proceedings be documented for submission for publication, but it may very well lead to other conferences that focus on respiratory compromise in other settings. Both the skilled nursing facility and long-term acute care hospital settings provide care for a spectrum of pulmonary/ventilator patients, and the characteristics of their potential cascade of deterioration may or may not be the same as in an acute care hospital. The challenges are similar, but solutions may be different—a subject for further discussion.

This conference is just one example of NAMDRC’s approach to a range of pulmonary-related clinical issues. While NAMDRC’s broad mission is to “improve access to quality care for patients with respiratory disease by removing regulatory and legislative barriers to appropriate treatment,” the roundtable does fit into the mission because of growing concerns that we are facing challenges that are solvable if we take the initiative to address solutions to these challenges.

Another very broad challenge facing NAMDRC is its belief that the growing area of home mechanical ventilation is being shaped by archaic and outdated legislation and regulation. In fact, in a discussion with Marilyn Tavenner, CMS Administrator (and critical care nurse by training) last August, she conceded that the laws and regulations have not kept pace with innovations as basic as noninvasive mechanical ventilation. The idea that mechanical ventilation involves intubation or tracheostomy is universally recognized as archaic. As archaic is the concept that, by definition, ending mechanical ventilation leads to imminent death. While that may have reflected technologies of the 1980s and early 1990s, it is not reflective of today’s standards of care. Amending the existing laws and regulations in this area may become a high priority for NAMDRC over the next few years.

For membership information, visit the NAMDRC website at www.namdrc.org or call 703/752-4359.

NAMDRC is bringing together representatives of key medical societies, including CHEST, ATS, AARC, SCCM, AACN, SHM (hospitalists), PPAHS (patient safety), and ACEP (emergency physicians) to address respiratory compromise, that cascade of events that moves from respiratory insufficiency to respiratory failure to respiratory arrest. Recognizing that respiratory compromise occurs in various settings, the conference, Feb 26-27 in Orlando, Florida, will focus on the hospital setting.

In addition to society representatives, the NAMDRC leadership, in consultation with recognized experts, has also invited several key opinion leaders to participate, including physicians, respiratory therapists, and nurses.

There are several challenges facing the participants, perhaps paramount is to define the concept of “respiratory compromise.” Some of have signaled, “I know it when I see it,” but the expectation is to formulate a specific clinical definition of the respiratory deterioration, and devise a recognition pathway that can easily be used in the hospital setting to identify patients earlier in the course of this cascade.

How to identify high risk patients is critical to the discussion, because it is generally believed that this is where resources need to be focused, both from a personnel and monitoring perspective. Can consensus be drawn to determine which patient characteristics can reliably classify that patient into a high risk for respiratory compromise, and, if so, those characteristics should be delineated. The corollary challenge is to identify the low risk patients so that inappropriate resources are not focused where such efforts might not be necessary.

Individual hospital policies are integral to this issue, as the relative value of rapid response teams appears to vary greatly. Add to the equation a recent Wall Street Journal article (http://online.wsj.com/search/term.html?KEYWORDS=Heart%20attack) that highlighted the success of managing heart attacks outside the hospital but the notable challenges of managing those events when they occur within the inpatient population.

Another key challenge facing roundtable participants will be to focus their discussions on what clinical parameters should be monitored and which, if any, should be put on the back burner. There is a relatively wide variation of views regarding what should be monitored, what thresholds are problematic and indicative of a declining patient, and what actions need to be taken, and how swiftly, to abate the downward cascade of respiratory compromise. A related challenge facing participants is, “should the industry be moving toward refinement of their monitoring technologies to give physicians and the health-care team more valuable and more timely information? Are we monitoring the right parameters, or are we monitoring what the technology allows us to monitor? Are there gaps that can be addressed?”

While no one is confident of the specific direction these discussions will take, it is likely that not only will the proceedings be documented for submission for publication, but it may very well lead to other conferences that focus on respiratory compromise in other settings. Both the skilled nursing facility and long-term acute care hospital settings provide care for a spectrum of pulmonary/ventilator patients, and the characteristics of their potential cascade of deterioration may or may not be the same as in an acute care hospital. The challenges are similar, but solutions may be different—a subject for further discussion.

This conference is just one example of NAMDRC’s approach to a range of pulmonary-related clinical issues. While NAMDRC’s broad mission is to “improve access to quality care for patients with respiratory disease by removing regulatory and legislative barriers to appropriate treatment,” the roundtable does fit into the mission because of growing concerns that we are facing challenges that are solvable if we take the initiative to address solutions to these challenges.

Another very broad challenge facing NAMDRC is its belief that the growing area of home mechanical ventilation is being shaped by archaic and outdated legislation and regulation. In fact, in a discussion with Marilyn Tavenner, CMS Administrator (and critical care nurse by training) last August, she conceded that the laws and regulations have not kept pace with innovations as basic as noninvasive mechanical ventilation. The idea that mechanical ventilation involves intubation or tracheostomy is universally recognized as archaic. As archaic is the concept that, by definition, ending mechanical ventilation leads to imminent death. While that may have reflected technologies of the 1980s and early 1990s, it is not reflective of today’s standards of care. Amending the existing laws and regulations in this area may become a high priority for NAMDRC over the next few years.

For membership information, visit the NAMDRC website at www.namdrc.org or call 703/752-4359.