Because of a multidisciplinary team from the Veterinary Teaching Hospital led by Bobbi Conner, clinical associate professor and service chief in emergency and critical care, the Virginia-Maryland College of Veterinary Medicine now can provide mechanical ventilation for patients in long-term care.
To do it, they had to find a mechanical ventilator during a global pandemic.
The Veterinary Teaching Hospital has had a medical air system for 20 years but needed a veterinary specialist called a criticalist to operate it. Because there's a shortage of criticalists — there are fewer than five in Virginia — no one at the hospital had the expertise necessary to safely ventilate long-term.
"The machine we had was essentially a transport ventilator, which physicians might use if they have to transport a patient from one hospital to another. It's meant for very short-term use, just for transport on an ambulance or a helicopter, so about an hour or two," Conner said.
A criticalist deals with the sickest patients and typically oversees an intensive care unit (ICU). After the hospital's emergency team has triaged an ill or injured pet and emergency treatments have started, a criticalist will help stabilize and take care of the pet in the ICU. The criticalist collaborates with all the necessary departments and specialists on challenging cases to provide comprehensive care.
Providing mechanical breathing for patients in longer-term care supports those in critical condition. "When breathing is difficult for the body, it requires a lot more energy, leading to respiratory failure. These are cases when having a mechanical ventilation machine is useful because we can take over the work of breathing and give that animal a break by providing additional support until whatever muscles or nerves can be healed and the patient can breathe for themselves," said Conner.
When Conner was hired in August 2020, she saw an opportunity to expand the Veterinary Teaching Hospital's emergency care options. "When I got here, I realized our capabilities for providing mechanical ventilation were not where they could be, so I spent several months working on getting our infrastructure up and running, replacing a 20-year-old, non-functional medical air compressor." Next, Conner searched for a user-friendly mechanical ventilator, a challenge because of the pandemic.
"I didn't know for sure when it was going to happen. Ventilators were also not necessarily the easiest to come by, certainly at the pandemic's peak. It was widespread for veterinarians to donate their ventilators to human hospitals. There was a period where there was no way we would be able to purchase a ventilator," Conner said.
After months of patience, contacting distributors and manufacturers, and getting input from the broader critical care community, Conner finally secured a machine.
But mechanical ventilation is a complex, dangerous process that requires special training. "It's usually not the first measure we take, and we try to avoid it because it's problematic," said Conner.
Being put on a ventilator is not a simple task. "It involves putting a breathing tube in, an endotracheal tube. Then we determine on the machine what settings to use to deliver breaths. It's not the natural way to breathe for many reasons. It's not completely benign, and you must be careful," said Conner.
Conner is the only criticalist at veterinary college. Since she arrived, she's brought myriad knowledge and skills that bolster the hospital's services. "This was not being offered as a service primarily because there wasn't the expertise to do it. If you don't have a criticalist, you don't have anybody who's trained specifically on mechanical ventilators. There's a difference between long-term ventilation and short-term ventilation," Connersaid.
Conner's efforts paid off earlier this year when the first patient was successfully treated with the new mechanical ventilator. "We finally got this specialty service up, and shortly afterward, we had our first opportunity to use it. Neurology had a patient with a disk herniation in the neck that impacted the dog's ability to breathe normally. They took her to MRI and then surgery, and she recovered on the ventilator for a few days. She would not have survived without these interventions, but today the dog is doing very well and we are hopeful she will continue to recover well," said Conner.
With the new machine up and running, Conner is looking ahead to how to develop the critical care teaching and training opportunities for students. "There's a huge need for additional critical care training, and one of our long-term goals is to build the program enough to hire a second criticalist and then start a residency program," she said.
Written by Florence Gonsalves M.F.A. '23