Respiratory Drive Testing

Details

Title

Respiratory Drive Testing

Type

Stage Two

Module code

HPS170

Requirement

Compulsory

Module objective

By the end of this module Clinical Scientists in HSST will be able to analyse, synthesise, evaluate and apply their knowledge to be competent in the management, delivery, interpretation and reporting of a multi-modal respiratory drive testing service within scope of practice of Consultant Clinical Scientist.

Knowledge and understanding

By the end of this module the Clinical Scientist in HSST will analyse, synthesise, evaluate and critically apply their expert knowledge with respect to: 

• the physiological principals of respiratory drive.
• the physiological and pathophysiological conditions that affect respiratory drive.
• the theoretical principles that dictate the performance of multiple modes of respiratory drive measurement including:
  • P0.1 (mouth occlusion pressure)
  • hypercapnic drive
  • hypoxic drive
  • diaphragm EMG (including surface measurements where appropriate)
  • pressure-volume (work of breathing) using oesophageal / gastric catheters
• current best practice with regards to safety aspects when conducting respiratory drive measurements.
• the absolute and relative contraindications to testing.
• the appropriate equipment safety checks required.
• the appropriate infection control procedures.
• the appropriate use of local anaesthesia as required by the technique used
• the established quality control and quality assurance procedures for:
  • calibration procedures
  • quality assurance testing
• the application of different test modalities in different patient groups and different test scenarios (lab based, bedside, ITU etc).

Technical and clinical skills

By the end of this module the Clinical Scientist in HSST will be able to demonstrate a critical understanding of current research and its application to the performance and mastery of the following technical skills:

• perform measurements of respiratory drive using invasive and non-invasive techniques in accordance with published standards, ensuring health and safety criteria are met
• for invasive techniques, to correctly place oesophageal catheters for EMG measurements ensuring appropriate local anaesthesia is used
• perform non-invasive respiratory drive assessments, recognising mechanical or patient technical errors and rectifying appropriately
• construct safe and reliable breathing circuits (using either special gas mixes / demand valve or rebreathing circuits with “gas scrubber” systems)
• ensure equipment has been appropriately verified as suitable for use based on established quality control and quality assurance procedures including:
  • calibration procedures
  • quality assurance testing
• select the appropriate protocol and method of testing
• review the recorded data in real-time

By the end of this module the Clinical Scientist in HSST will be expected to critically reflect and apply in practice a range of clinical and communication skills to advise and communicate effectively with patients, relevant clinicians, patients and the public and other healthcare professionals and will:

• determine the appropriateness of test completion, respiratory drive modality selection and utilisation of information during interpretation and report. generation, based on referral information and past medical history, including symptoms from the patient.
• perform risk management and highlight potential problems prior to testing.
• perform definitive analysis of recorded physiological data utilising current best practice guidelines in relation to reason for referral
• provide detailed physiological interpretation of respiratory drive studies based on published guidance.
• develop test reports based on requirements of referring clinician ,previously published evidence and past medical history.
• provide information to the referrer on the potential causes of the reason for referral.
• provide feedback to patient, where appropriate, outcomes of investigations with a specified follow-up plan.perform definitive analysis of recorded physiological data utilising current best practice guidelines in relation to reason for referral.
• discuss with multi-disciplinary teams potential differential diagnoses and recommendations for further assessment or required intervention.

Attitudes and behaviours

By the end of this module the Clinical Scientist in HSST will be expected to evaluate their own response to both normal and complex situations demonstrating the professional attributes and insights required of a Consultant Clinical Scientist working within the limits of professional competence referring as appropriate to senior staff and will:

• maintain patient confidentiality throughout investigations and reporting of outcomes.
• continually investigate potential improvements to delivery of a respiratory drive testing programme.
• promote the importance of active participation by Clinical Scientists in multidisciplinary clinical team meetings.