Respiratory Therapist and Web Developer

Thomas Piraino RRT, FCSRT

Thomas PirainoI am a Registered Respiratory Therapist currently working as the Clinical Specialist - Mechanical Ventilation at St. Michael's Hospital in Toronto Ontario.  I am also an Assistant Clinical Professor (Adjunct) in the Department of Anesthesia, Division of Critical Care at McMaster University.

I am on the editorial boards for the Respiratory Care Journal (the scientific journal of the American Association of Respiratory Care), and the Canadian Journal of Respiratory Therapy.

Work Experience

Clinical Specialist - Mechanical Ventilation, St. Michael's Hospital Toronto 2017 - Present

Assist in the implementation of research, innovation, and knowledge translation related to mechanical ventilation at St. Michael's.  Develop strategic academic and industry alliances to advance knowledge and impact care of critically ill patients nationally and internationally.

Best Practice Clinical Educator, St. Joseph’s Healthcare Hamilton 2009-2017

Typical duties include: Responsible for the day-to-day practice issues related to Respiratory Therapy at SJHH, creation and implementation of policies, procedures, and Medical Directives, provide education related to Respiratory Therapy throughout the organization for all health care disciplines including Nursing, Medical Residents, and Critical Care Fellows. Provide support for Respiratory Therapy staff with professional goals and education, and support ongoing research within the hospital when related to the duties of Respiratory Therapists

Clinical Leader for Respiratory Therapy, McMaster University Medical Centre(MUMC) Hamilton 2008-2009


Typical duties include: Responsible for the day-to-day practice issues related to Respiratory Therapy at MUMC, creation and implementation of policies, procedures, and Medical Directives, provide education related to Respiratory Therapy throughout the organization for all health care disciplines including Nursing, Medical Residents, and Critical Care Fellows. Provide support for Respiratory Therapy staff with professional goals and education, and support ongoing research within the hospital when related to the duties of Respiratory Therapists. Work in partnership with RT Educator to provide in-services and support for staff.

Respiratory Therapist, McMaster University Medical Centre Hamilton 2006-2008

Typical duties include: Adult mechanical ventilation and weaning in the ICU as per HHS medical directive, assisting with bronchoscopy, percutaneous tracheostomy, and in and out of hospital transport of patients. High Frequency Oscillation and other open lung strategies Wards, ER, and CRCU coverage. Respond to all cardiac and respiratory arrests. Procedures include intubations, ABG punctures, spirometry, and bronchodilator therapy.

Respiratory Therapist, Toronto General Hospital 2003-2009

Typical duties include: Adult mechanical ventilation and weaning in the MSICU and CVICU as per medical directive, assisting with bronchoscopy, percutaneous tracheostomy, and in and out of hospital transport of patients. High Frequency Oscillation and High Frequency Jet Ventilation Wards, ER, and PACU coverage. Respond to all cardiac and respiratory arrests. Procedures include intubations, ABG punctures, spirometry, bronchodilator therapy, arterial line insertions, write orders and initiate treatments such as arterial blood gases, bedside spirometry, MDI/aerosolized medication treatments, Heliox therapy, and tracheostomy changes, according to Respiratory Therapy medical directives.

Awards and Recognitions

The Canadian Society of Respiratory Therapists (CSRT) - 2016

Colya Kaminiarz Professional Achievement Award


Awarded to a CSRT member who has made a significant contribution to professional practice and/or has influenced others toward higher levels of achievement in professional practice.

Fanshawe College - 2016

Distinguished Alumni Award


The Distinguished Alumni Awards program honours individuals who have graduated from a Fanshawe College program and who have used their skills to improve themselves, their career field, their community, and their world.

The Respiratory Therapy Society of Ontario (RTSO) - 2015

President's Award

Selected by the RTSO President in recognition of a RTSO member who has contributed greatly to the practice of Respiratory Therapy in Ontario.

The Michener Institute - 2013

Excellence in Clinical Teaching and Supervision

Annual recognition of excellence related to the reaching of Respiratory Therapy students.

Hamilton Health Sciences - 2007

Respiratory Therapy Award of Excellence


Annual recognition of outstanding practice in the field of Respiratory Therapy.

Fanshawe College 2003

Victor Mosher Award


Awarded to a graduating student who demonstrates exceptional technical skills, outstanding leadership and professionalism.

Scientific Presentations

Canadian Society of Respiratory Therapists Education Conference

The Epidemiology of ARDS Management (2018)
Preventing Ventilator Associated Pneumonia: Where is the Benefit? (2017)
Decision Drivers and Patient Safety: A Reflection on the Use of Inhaled Pulmonary Vasodilators (May 2016)
Can bladder pressure be used to set optimal PEEP? (May 2015)
Ventilator Waveform Analysis (May 2014)
Individualizing Mechanical Ventilation for the ARDS Patient (June 2013)
Asynchrony During Mechanical Ventilation (June 2012)
The Use and Application of Nitric Oxide (June 2011)

American Association of Respiratory Care Congress

Prone Positioning in Moderate ARDS (2017)
A Hypothesis on the Impact of Subglottic Secretion Tubes (2016)
Pressure Support, Asynchrony, and Atrophy (November 2015)
Management of ARDS and When to Consider ECLS (November 2015)
Monitoring Mechanical Ventilation (December 2014)
Can Bladder Pressure Be Used to Set Optimal PEEP (November 2013)
Transpulmonary Pressure (November 2012)

Ontario Respiratory Care Society

The Evolution of Lung Protection in Critical Care (2017)
Transitioning to Pressure Support Ventilation (November 2015)
Visualizing Ventilation: The future of bedside ventilation monitoring (June 2015)
Prone Positioning for Hypoxemic Respiratory Failure in ARDS (June 2014)
Bedside Selection of Optimal PEEP (2009)

Canadian Critical Care Forum

Monitoring Mechanical Ventilation at the Bedside: Severe ARDS (October 2015, 2014)
Individualized Mechanical Ventilation (October 2012)

College and Association of Respiratory Therapists of Alberta Education Symposium

The Future of Respiratory Therapy in Critical Care (October 2016)
Decision Drivers and Patient Safety: A Reflection on the Use of Inhaled Pulmonary Vasodilators (October 2016)
Considerations for Prone Positioning (October 2014)
Mechanical Ventilation of the Pneumonia Patient (October 2014)
Ventilation of the ARDS Patient (October 2012)
Oxygenation of the ARDS Patient (October 2012)

Canadian Critical Review Program

Basic Ventilator Settings and Controls (June 2015)

Manitoba Association of Registered Respiratory Therapists Education Forum

Ventilator Associated Events: Should we abandoned VAP? (April 2018)
Prone Positioning in Moderate ARDS (April 2018)
Managing ARDS and when to consider ECLS (May 2016)
The Future of Respiratory Therapy in Critical Care: Will Technology Take Over? (May 2016)
Waveforms to Detect Asynchrony (May 2015)
Mechanical Ventilation Monitoring. So Many Tools Today! (May 2015)

Saskatoon College of Respiratory Therapists Education Conference

PEEP: 50 Years of Uncertainty (September 2016)
Visualizing Ventilation: The future of bedside ventilation monitoring (September 2015)

Publications

Editorials

Piraino, Thomas, and Eddy Fan. 2018. “Airway Pressure Release Ventilation in Patients with Acute Respiratory Distress Syndrome: Not Yet, We Still Need More Data!” Journal of Thoracic Disease 10 (2): 670–73.

Piraino T, Fan E. Acute life-threatening hypoxemia during mechanical ventilation. Current Opinion in Critical Care. 2017 23(6):541–548

Piraino T. Decremental PEEP Titration: A step away from the table. Respir Care. 2013 May;58(5):886-8

Case Reports

Cook D, Piraino T. Optimal PEEP Guided by Esophageal Balloon Manometry. Respir Care. 2011 Apr;56(4):510-3

Piraino T. Applying Transpulmonary Pressure in the ICU. ICU Volume 11 Issue 4 Winter 2011/2012

Piraino T. The Use of Transpulmonary Pressure to Set Optimal PEEP: A Case Report. Canadian Journal of Respiratory Therapy. Summer 2010 Volume 46.2

Reviews

Junhasavasdikul, Detajin, Irene Telias, Domenico Luca Grieco, Lu Chen, Cinta Millan Gutierrez, Thomas Piraino, and Laurent Brochard. 2018. “Expiratory Flow Limitation During Mechanical Ventilation.” Chest, February.

Piraino T. 2016 Year in Review: Noninvasive Ventilation. Respir Care May 2017, 62 (5) 623-62

Original Research

Duan EH, Adhikari NK, D’Aragon F, Cook DJ, Mehta S, Alhazzani W, et al. Management of ARDS and Refractory Hypoxemia: A Multicenter Observational Study. Annals of the American Thoracic Society 2017 DOI: 10.1513/AnnalsATS.201612-1042OC

Citation: Burns KEA, Rizvi L, Dodek P, Lamontagne F, Seely AJE, et al. (2016) Frequency of Screening and SBT Technique Trial. J Clin Trials 6:284. doi:10.4172/2167-0870.1000284

Kho ME, Molloy AJ, Clarke FJ, Ajami D, McCaughan M, Obrovac K, Murphy C, Camposilvan L, Herridge MS, Koo KKY, Rudkowski J, Seely AJ, Zanni JM, Mourtzakis M, Piraino T, Cook DJ, and the Canadian Critical Care Trials Group.  TryCYCLE: A Prospective Study of the Safety and Feasibility of Early In-Bed Cycling in Mechanically Ventilated Patients.  2016. PLoS ONE 11(12): e0167561

Sindi A, Piraino T. The Correlation Between Esophageal and Abdominal Pressure in Mechanically Ventilated Patients Undergoing Laparoscopic Surgery. Respir Care 2014;59(4):491–496 Katsios C, Ye C, Hoad N, Piraino T, Soth M, Cook D. J. Intra-abdominal hypertension in the critically ill: Interrupter reliability of bladder pressure measurement Crit Care. 2013 Oct;28(5):886

Book Chapters

Soth M, Piraino T. Chapter 9: Non-invasive mechanical ventilation. Handbook of ICU Therapy 3rd Ed. Cambridge University Press, 2015

Piraino T. Monitoring the Patient in the Intensive Care Unit. Chapter 51, Egan’s Fundamentals of Respiratory Care 11th Ed. Elsevier, 2016