Implementation of a Remote Respiratory Therapy in a Donor Center ICU Using a Telecritical Care Platform.

Abstract

To evaluate the feasibility, safety, and operational impact of delivering comprehensive remote telecritical care respiratory therapy (eRT), including full ventilator management, in a dedicated brain-dead donor care ICU. Prospective observational study conducted over a 12-month period (from October 2023 to October 2024). An eight-bed brain-dead donor care ICU utilizing a telecritical care platform with real-time audiovisual monitoring and remote ventilator interface capability. Organ donors (n = 182) managed during the study period. All respiratory therapy (RT) care, including ventilator management and procedural support, was delivered remotely. In-person RT support was available as needed. Procedural workload, in-person RT utilization, safety events, donor outcomes, and full-time equivalent (FTE) labor requirements were recorded. eRT completed 3872 respiratory procedures, totaling 1782 hours of remote care. In-person RT support was required for 119 hours (6.1%), primarily for transport and advanced airway interventions. No airway losses, emergency RT activations, cardiac arrests, or delays in care occurred. Remote RT support resulted in an estimated savings of 2.2 FTEs and $306,952 in avoided labor costs. A total of 520 organs were procured, with an observed-to-expected recovery ratio of 1.19. Comprehensive remote RT, including full ventilator management, was safely and effectively implemented in a donor care ICU. This model substantially reduced bedside staffing requirements while maintaining favorable donor outcomes, supporting broader adoption and highlighting the need for regulatory pathways enabling secure remote ventilator access.