For Shelby, a registered respiratory therapist (RRT) in the Cardiovascular Intensive Care Unit (CVICU) at Arkansas Children’s Hospital (ACH), New Year’s Day in the CVICU was like most other days at work. Patients in the CVICU require round-the-clock monitoring and care, including holidays and weekends, which means that at least two respiratory therapists always staff the unit. 

Shift Begins, 6:30 a.m. 

Every morning at work begins with the same routine for Shelby, and this day is no different. He and two other CVICU respiratory therapists started 2024 with an update from the RRTs who worked overnight on New Year’s Eve.  

“[The night shift] tells us if a patient is sicker than we left, or if anyone is being med-flighted in, or if there are any surgeries,” Shelby said. 

Based on the updates, Shelby and his colleague create the day’s list of treatments or therapies needed for each patient. Typically, the two primary respiratory therapists each treat six to eight patients every day. Many patients are in long-term care, so frequently, each RRT will be assigned patients they’ve treated before. Developing relationships with the patient and their caregivers provides comfort during a stressful time, like waiting for a heart transplant. Strong relationships between respiratory therapists and caregivers have other benefits, too. 

“The mood of the family and the patient and the connectedness – it helps them heal faster,” Shelby said. 


Mornings are the busiest for respiratory therapists at ACH because almost all patients start the day with a treatment. Some patients need only one or two treatments daily. In contrast, others may require four or more at regular intervals throughout Shelby’s 12-hour shift.  

The most common respiratory therapy treatments use an intrapulmonary percussive ventilator (IPV) or high-flow nasal cannula (HFNC) to support or strengthen a patient’s heart and lungs. When healthy, the heart and lungs work together to provide oxygen to the body. Patients born with a congenital heart condition or who develop cardiomyopathy need assistance getting oxygen. Without respiratory treatments, their weakened heart or lungs experience unhealthy strain. 

“We’re going to help the patient’s heart relax,” Shelby said when a patient’s condition unexpectedly changed midmorning, requiring an additional treatment. 

An IPV treatment pushes bursts of air into the lungs, which helps clear mucus. The air around us contains around 21% oxygen in normal breathing conditions. An HFNC treatment delivers heated and humidified air into the body, allowing a patient’s heart to pump less strenuously by tripling the amount of oxygen gained in a single breath.  

These treatments take approximately 15 minutes, but Shelby and the ACH respiratory therapists often spend extra time with patients, answering any questions and reducing anxiety. 

“Whenever you get into a patient’s room, you treat it like you have nothing else to do for the rest of the day,” Shelby said. 

In addition to the two primary respiratory therapists, one or two floating respiratory therapists frequently join the team in the CVICU. Shelby said ACH employs more respiratory therapists than most hospitals, which ensures every patient gets the care they need without straining the system. 

After each treatment, the respiratory therapist updates the patient’s chart, ensuring the other care team members, including physicians and nurses, have up-to-date information. 

Holiday Differences

By 11 a.m. on New Year’s Day, Shelby has provided at least one treatment for the eight patients he’s assigned. The holiday is less busy than a typical day, because there’s less chance that a patient will need to be transported elsewhere in the hospital for testing or scans. ACH uses battery-operated ventilators to ensure uninterrupted delivery of necessary care if a patient needs an MRI, for example.  

The 12-hour shift means Shelby spent most of the holiday away from family. He said those on duty support each other and find ways to enjoy the holiday, like sharing potluck meals.  

At the end of his shift, he and his day-shift colleague update the incoming night-shift respiratory therapists, passing the baton of exceptional care. 

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