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Jesse Rodriquez

Hitting All the Right Notes in Respiratory Care

By Laura Kuhn

Anyone who has ever picked up an instrument can appreciate the tremendous dedication it takes to actually make music. It takes practice. Time. Patience.

The most basic music-making ingredient, and something that many of us take for granted, is breath. Breath can make a piccolo's notes pierce the air of a concert hall or allow a tuba's deep resonance to be felt in the very last row.

It's safe to say that breath isn't something that musicians take for granted - and that could be one reason that Jesse Rodriguez, Respiratory Therapy Director at Glenbridge Nursing and Rehab Center in Niles, Illinois, is so good at what he does. An accomplished trombonist, percussionist and band director, Rodriguez empathizes with anyone who struggles to breathe.

"I appreciate the lungs a lot more knowing the amount of air it takes to perform as a professional musician," he said. "It's a personal thing for me. It's a tough thing to watch somebody struggle for their breath. When we can make their lives easier, that's a great thing."

Twenty-five years of dedication

Rodriguez has worked in respiratory therapy for the past 25 years. Early in his career, he worked a weekend stint through an agency at a long-term care facility. Before that, he was on the hospital circuit, working in trauma units and in transport. The long-term care setting was a revelation for him.

"I liked it. I felt at home," he recalls. "The ability to deliver individualized care was so different from the fast-paced environment I was working in, where I would see someone for 15 minutes and then never see them again. In long-term care, I could get involved with a person on a more personal level."

He began picking up more and more shifts at long-term care facilities and eventually began working in the field full time.

Growth and evolution in respiratory care

Over the years, Rodriguez has seen major changes come to respiratory care, in everything from equipment to acuity. When he entered the field, there were two major brands of tracehostomies and three or four different styles of tubes. "Demos have gone from a few tubes to maybe 25 that I'm showing in an in-service," he said. "We now have individual tubes for individual applications."

Ventilators, too, have become much more sophisticated. "The ventilators in long-term care have every bell and whistle that a hospital ventilator has so that patients can transition smoothly from one setting to the next," he said. "That used to be a problem in the past."

Many facilities, Rodriguez's included, have elected to purchase arterial blood gas machines so that they can draw arterial blood gases and check a resident's oxygenation status on the spot. "Point of care has really come into play," Rodriguez noted.

Care, too, has become more complicated. "In this environment, we're dealing with more and more complex cases," Rodriguez said. "There are cases the hospitals can't keep, so we adapt to be able to care for those individuals."

With all of these changes, knowledge is key. "You have to be sharp," Rodriguez said. "I really encourage my therapists to learn as much as they can and stay on top of things."

Specific challenges

Fibrosis, COPD and pulmonary infections
The diseases and conditions that Rodriguez and his team are confronting in long-term care have also changed over the years. He reports seeing an increase in fibrotic lung disease. "With the fibrotic lung disease, I think there are more environmental attributes, such as building materials that weren't previously thought of as being dangerous," he said. "A lot of materials can cause fibrosis."

Chronic obstructive pulmonary disease, or COPD, has also become more prevalent. "The incidence of COPD has skyrocketed and we're dealing with that," Rodriguez said. "The COPD cases that we're treating now frequently become our long-term residents and may wind up with airway or ventilator care in our facilities."

Pulmonary infections remain a challenge, Rodriguez said. "We've been giving nebulized antibiotics for the past eight or 10 years. Even those are more complex now. The resistant bacteria that we encounter are presenting more and more challenges financially." To help address this, Glenbridge brought in a group of infectious disease physicians to work with the respiratory therapy team and provide expert guidance on treating and clearing infections.

CPAP and BiPAP compliance
With sleep apnea's prevalence in long-term care, Rodriguez and his team frequently handle issues with continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) mask compliance. Rodriguez is blunt with residents who don't want to wear their masks: "You have to let them know it's a life and death choice not to wear it."

That said, there is a lot that caregivers can do to make wearing the masks easier. "Compliance is all about comfort," Rodriguez said. "The first thing I would encourage is to get a proper fitting. Respiratory therapists have to be knowledgeable about all of the sleep therapy products out there so that when we fit someone, we fit them properly and utilize the best choices. Just like everything else we do, we have to individualize a plan of care." Rodriguez points out that addressing leaks on sleep masks can be particularly challenging, but is manageable through a proper fitting.

Ventilator reliance
Rodriguez is especially proud of Glenbridge's capability for weaning people off of ventilators. "We've pretty much perfected it. We're at the top of our game," he said. "We can take people who are on a ventilator, assess them, form a plan of treatment for them and get them off the ventilator a lot quicker than we did in the past," he said. "We're not talking about a life sentence when you go on a ventilator. Our goal is decannulation for anyone who comes through the door."

Added benefits of having a respiratory therapist on staff

"It's an additional expense for a facility to incur, but the benefits of having a respiratory therapist are pretty obvious," said Rodriguez. "Many companies are hiring therapists simply because their outcomes improve, especially when you're talking about residents who come from the hospital and want to avoid exacerbating their diagnosis and winding up in the hospital again."

Families and residents have also become more savvy and are looking for facilities that have a therapist on staff, Rodriguez noted.

Reflecting on 25 years in respiratory care, Rodriguez is pleased with where the field is heading. "With respiratory therapists and pulmonary physicians working together, we can get a lot done," he said.