Not utilizing CRNAs to their full training is a disservice to COVID patients

  • May 7, 2020

By Julie Ciaramella
AANA Public Relations & Communications

When elective surgeries were canceled at her Florida hospital, Lea White, CRNA, had a choice: take a voluntary unpaid leave of absence, or go to New York City to fight COVID-19 on the front lines in the pandemic’s epicenter.

She chose to go to New York.Lea White

After accepting a three and a half week contract, White, along with three other CRNAs from Florida, Tennessee, and North Carolina, traveled to work at a community hospital in Nyack, N.Y., about 15 miles north of Manhattan.

“I didn’t realize the magnitude of the disease until I got here,” she said. “When you see it firsthand, it takes you aback.”

The hospital decided to use White and her colleagues in an innovative way, by having them work to wean patients off mechanical ventilation when the patients are ready to do so. Weaning is a process that decreases the amount of support the patient receives from the ventilator and allows them to breathe on their own.

“The ventilator will only kick in if they don’t breathe at all,” White said. “We test them—we see how much pressure they need to support their ventilation, and then we dial down the pressure until they’re completely weaned off the ventilator and we feel comfortable removing the endotracheal tube. If the patient can breathe on their own with minimal pressure support, that’s a really good trial.”

CRNAs are ventilation management experts and ensure the weaning trials are done safely. The trials last anywhere from 15 minutes to two hours, and the patients have four or five chances per day to breathe on their own. If the CRNAs weren’t there, the patient would only have one chance, White said. Patients are having better outcomes by having more than one chance to wean.

The CRNAs are working closely with the hospital’s intensivists, formulating a plan at the beginning of each day of what they want to do for each patient. Each CRNA is caring for up to 15 patients, and they are constantly assessing those patients to provide the best possible care.

White said she is also speaking to patients’ families as the patients are being weaned off mechanical ventilation. For one patient, she called his family and they played music he liked during the weaning trial and spoke to him. Even though the patient was intubated and a little sedated, his eyes were open. His heart rate came down as his wife talked to him.

“We try to incorporate the family and things the patient likes from home to help them get through this difficult time,” White said.

Once patients are placed on a ventilator, they tend to stay on it for 10 to 14 days. Their lungs are stiff, and their blood pressure is hard to manage because of the pressure on the lungs. It’s a long process to wean them off mechanical ventilation, a continual battle to find what medications, positions, and levels of sedation work for them.

“It’s a constant ebb and flow as far as treatment,” White said, but she and other CRNAs have been up to the challenge thanks to their backgrounds in critical care nursing. They are making a difference, serving as a resource for other providers and supporting each other as they tirelessly care for patients.

“We’re one of the only specialties that can be placed in an ICU setting and thrive. We help every single specialty—the intensivists, the nurses, the respiratory therapists, the nursing assistants,” she said. “We are so uniquely qualified.”

White said it would be doing a disservice to COVID patients not to utilize CRNAs to the full scope of their training, since there’s so much they can do to care for patients, from ventilator management, to airway management, intubation, extubation, sedation, and more.

“It would be a real shame for us not to be utilized in a pandemic because there isn’t another specialty that can do what we can do, which is everything,” she said.