John directs ChristianaCare’s Respiratory Department, which has achieved the American Association for Respiratory Care's APEX recognition. He is a fellow of this association and has been a registered respiratory therapist for 29 years. John is a national lecturer, researcher, Lean Six Sigma Blackbelt as well as a Certified Professional in Healthcare Quality.
Areas of Expertise (3)
Wilmington University: MBA HCA
Millersville University of Pennsylvania: B.S., Biology, Respiratory Care 1994
Selected Papers and Publications (9)
Feasibility of a Multi-Center Respiratory Therapist Endotracheal Intubation StudyRespiratory Care
2023 BACKGROUND: Respiratory therapists (RTs) have historically performed safe and effective intubations, yet there are limited multi-center data assessing their intubation performance. Multi-center data can be used to compare RT intubation performance to that of other professions and identify quality improvement opportunities at hospitals where RTs perform intubation. We aimed to explore the feasibility of a multi-center collaborative to evaluate RT intubation outcomes.
Retrospective Review of Transpulmonary Pressure Guided Positive End-Expiratory Pressure Titration for Mechanical Ventilation in Class II and III ObesityCritical Care Explorations
2022 Objectives: Acute respiratory distress syndrome is treated by utilizing a lung protective ventilation strategy. Obesity presents with additional physiologic considerations, and optimizing ventilator settings may be limited with traditional means. Transpulmonary pressure (PL) obtained via esophageal manometry may be more beneficial to titrating positive end-expiratory pressure (PEEP) in this population.
PEEP Standardization to Reduce the Ventilator Associated Event Rate in Adult Surgical/Trauma and Neuro Critical Care UnitsAARC Conference
2019 Background: The Center for Disease Control (CDC) and National Health Safety Network (NHSN) have defined VAE as a deterioration in respiratory status following a period of stability-determined by PEEP or FIO2, evidence of inflammation or infection-determined by patient temperature and white blood cell count or lab evidence of a respiratory infection. VAE rate is defined as the number of events per 1000 ventilator days.
Impact of Laryngoscopy Type on Intubation Success RateAARC Conference
2019 Background: At our institution, respiratory therapists may be certified to perform endotracheal intubation in the adult population. Annual intubation certification includes both performing a certain number of successful endotracheal intubations as well as a passing a skills and knowledge test. Our practice has transitioned in the past few years from primarily using direct laryngoscopy to using video laryngoscopy. In the past, direct laryngoscopy was the main method available. Recently, our system placed a video laryngoscopy platform in all adult ICUs and Emergency Departments.
Bench Comparison of Two Adult Endotracheal Tube Clearing DevicesRespiratory Care
2019 Background: Two devices are available to clear partial occlusions of the adult endotracheal tube (ETT). Both devices claim the removal of secretions and biofilm from the ETT. There is limited information in the published literature about these devices and to our knowledge, no head to head comparisons on the performance of these devices to clear the lumen of a partially occluded ETT. We wanted to compare both devices in a bench model with simulated mucus for effectiveness to clear the ETT of a partial obstruction.
Innovating Neonatal Resuscitation Bags for Ease of Use in Diverse LocationsRespiratory Care
2015 The Chinese emperor Huang-Ti (2698–2599 BCE) noted that newborn death from ventilatory failure was common in premature infants.1 Galen (129–199 CE) inflated the lungs of deceased animals with a bellows and concluded that the air movement causes the chest to rise.1,2 Between 1850 and 1950, many techniques were used to resuscitate newborns, including swinging the infant upside down,1–3 rhythmic traction of the tongue, tickling, shaking, and yelling,2 and various other methods. In 1950, the first positive-pressure device was created to inflate infant lungs.4 Since that time, flow- and self-inflating manual resuscitation bag-valve devices have been developed to manually support infants requiring ventilation.
Work of breathing indices in infants with respiratory insufficiency receiving high-flow nasal cannula and nasal continuous positive airway pressurejournal of Perinatology
2014 Objective: To compare work of breathing (WOB) indices between two nCPAP settings and two levels of HFNC in a crossover study. Study Design: Infants with a CGA 28–40 weeks, baseline of HFNC 3–5 lpm or nCPAP 5-6 cmH2O and fraction of inspired oxygen ⩽40% were eligible. WOB was analyzed using respiratory inductive plethysmography (RIP) for each of the four modalities: HFNC 3 and 5 lpm, nCPAP 5 and 6 cmH2O. N=20; Study weight 1516 g (±40 g).
Decreased Incidence of Pneumothorax in VLBW Infants After Increased Monitoring of Tidal VolumesPediatrics
2012 Pneumothorax is common in very low birth weight (VLBW) infants. In our NICU, we noted an above average incidence of pneumothorax compared with similar NICUs based on Vermont Oxford Network benchmarking. The quality improvement project was designed to decrease the incidence of pneumothorax in VLBW infants in a tertiary care NICU.
Lung Hernia Associated With Hemothorax Following Cardiopulmonary ResuscitationRespiratory Care
2011 Lung hernia is an uncommon clinical occurrence. Lung hernia is defined as the protrusion of the lung through one of its bounding structures.1 Lung hernias are classified according to location (cervical, thoracic, or diaphragmatic) or cause (congenital, traumatic, or spontaneous). Thoracic-location lung hernias are most common and are highly associated with trauma.1,2 We report a case of a thoracic lung hernia associated with fractured ribs and hemothorax.
External Service & Affiliations (2)
- American Association for Respiratory Care : Fellow
- Delaware Society for Respiratory Care : Member
Selected Honors & Awards (1)
Lean Six Sigma Black Belt (professional)