When Truman Read, RRT, received the unusual call for help, there was no hesitation on his part to oblige the request. Read is a highly experienced critical care respiratory therapist, and it is not uncommon for medical professionals to seek out his advice and opinions; but even he admits that of all the requests he has received over his 30-plus years of experience as a clinician, this one was unique. He was asked to give a presentation on the physiology of ventilation to the staff at the New England Aquarium. The purpose of the presentation, he was told, was to help the aquarium staff to be better prepared for the upcoming turtle-stranding season.

Read attended an introductory meeting with Paul Nuccio, RRT, FAARC, director of respiratory care at Boston’s Brigham and Women’s Hospital; Charles Innis, VMD, associate veterinarian at the New England Aquarium; and other members of the aquarium staff to discuss the annual problem of stranding.

Intake picture of plastron. Notice the algae and the bilateral bruising common in severely cold-stunned turtles. Photos of “Dory” are courtesy of the New England Aquarium.

The Kemp’s ridley (Lepidochelys kempii) is the most seriously endangered sea turtle and among the most highly endangered species in the world. Although these turtles hatch in Mexico and primarily inhabit southern waters, many juveniles travel up the warm current of the Gulf Stream to the Northeast each summer.1

Strandings of hypothermic juvenile sea turtles are an annual late autumn event on Cape Cod. For reasons that are not fully understood, many endangered young sea turtles become caught on the north side of Cape Cod and fail to migrate south. As water temperatures plummet in Cape Cod Bay, those sea turtles slowly become hypothermic and float helplessly about the bay. If lucky, these gravely ill turtles with body temperatures as low as 45° are washed ashore by strong northwest winds.

Stranded sea turtles are brought to the New England Aquarium where the rescue and rehabilitation team treats them for hypothermia, dehydration, pneumonia, and other opportunistic infections. For those sea turtles in critical condition, Innis proposed utilizing a ventilator as a treatment method to aid in their recovery. Although in past years the staff has manually ventilated critical turtles for a short time using a resuscitator bag, he hypothesized that if they were able to use a mechanical ventilator, they might be able to improve the outcome for at least some of these turtles.

“Dory” after being brought to the NEAq from the Wellfleet Audobon Society.

After researching the literature, Read was able to include in his presentation information that was specific to the physiology of the sea turtle. According to Read, the sea turtle does not have a diaphragm and is able to breath-hold from 5 to 30 minutes, sometimes longer. The lungs can completely empty and fill in less than 3 seconds. The sea turtle has a special ability, due to a major adaptation in its brain, to endure total anoxia for many hours, allowing them to function in the absence of oxygen.2 “The presentation was quite fascinating” according to Nuccio. “To hear actual cases of previous turtles presented with information such as serial blood gases and electrolyte data was amazing.” Following the presentation, a discussion ensued as to how the aquarium might acquire an ventilator that could be used as a trial, in the event that critically ill turtles were once again transported there. Nuccio and Read saw this as a doable challenge.

With the help of specifications supplied by Innis and Read, Nuccio offered to utilize his contacts with many of the critical care ventilator manufacturers to investigate the acquisition of a high-tech ventilator. Nuccio contacted a handful of the top ventilator companies and explained what the need was and how he hoped that they would be willing to help. Of all the vendors that were contacted, Kevin O’Brien, RRT, New England sales representative for Maquet Inc, quickly stepped up to the plate. Within a day, O’Brien received approval from his company to provide a SERVO-i ventilator for use by the staff at the Aquarium. Read and Nuccio provided a heated humidifier and ventilator circuits, products of Fisher & Paykel Healthcare, to be used with the SERVO-i.

Bronchoscopy being performed by veterinarian Dr. Innis in the NEAq Animal Medical Center.

The equipment was set up in the aquarium’s ICU, and the staff was educated on the operation of the ventilator and accessories. The ventilator was preprogrammed for operation based on estimates of the anticipated turtle size. From this point, it became little more than a waiting game.

Two sea turtles were trialed on the SERVO-i this year. The first turtle was intubated for 1 hour before becoming strong enough to be taken off the ventilator and was able to survive for an additional 3 weeks. The second turtle was intubated for 2 days but was in such poor health that the rehabilitation team knew it would not recover and made the decision to remove the sea turtle from the SERVO-i.

“Since we had very few turtles this year, our use of the ventilator was limited,” said Innis. “Although both outcomes were unsuccessful, I do expect that there is a useful role for the ventilator in our rehabilitation efforts; however, we will need to perform more evaluations before we can be sure.”

“It was exciting to see the first turtle the week after extubation swimming around in a holding tank. It was unfortunate to hear that it ultimately suffered additional complications,” says Nuccio.

About the Ridleys’ Rescue

Each year in late fall, volunteers and staff of the Massachusetts Audubon Society comb certain beaches on Cape Cod in search of stranded, motionless turtles that have been washed ashore with the tide. Migrating north in the summer to feed on the rich supply of crabs in the area, the turtles that are found stranded are frequently inexperienced juveniles that become trapped when they try to head south in the fall. Hundreds have been saved over the years by such rescue efforts. The more seriously ill turtles are transported to the New England Aquarium in Boston, where they are slowly warmed to a safe temperature and evaluated by blood tests, x-rays, and ultrasound to determine their condition. The rehabilitation process—which includes being hand-fed with fresh clams—then begins.3

Following rehabilitation, which can take up to a year, the turtles are released on the beaches of Cape Cod after being tagged with satellite devices to track their progress. These releases are sometimes a public event, giving the volunteers a chance to observe the rewards of their efforts.

About the New England Aquarium

Located on the Boston waterfront, the New England Aquarium is one of the most prominent and popular aquariums in the United States. Its mission is to present, promote, and protect the world of water. Beyond its exhibit halls, the aquarium is also a leading ocean-conservation organization with research scientists working around the globe and biologists rescuing stranded marine animals in New England.4

Paul Nuccio, RRT, FAARC, is the director of respiratory care services and Truman Read, RRT, is a critical care respiratory therapist, Brigham and Women’s Hospital, Boston.

References

  1. Kemp’s ridley, Lepidochelys kempii. Available at: [removed]www.2fla.com/Kempsridley.htm[/removed]. Accessed April 16, 2008.
  2. Lutz PL, Bentley TB. Respiratory physiology of diving in the sea turtle. Copeia. August 5, 1985:671-9.
  3. Rescued turtles returned to sea. The Boston Globe. August 25, 2006. Available at: www.boston.com. Accessed April 17, 2008.
  4. Information provided by the New England Aquarium. 2007.