Respiratory therapy
Encyclopedia
Respiratory therapy is a healthcare profession in which specialists work with patients suffering from either acute or chronic respiratory problems. These specialists are termed Respiratory Therapists in most places internationally but may also be referred to as Respiratory Scientists or Respiratory Care Practitioners. Respiratory therapy clinicians are also sometimes referred to as cardio-pulmonary therapists or respiratory care practitioners. Respiratory therapists work independently and as part of a team to plan, integrate, and evaluate cardiac and pulmonary care. Respiratory therapists also recommend intervention and therapeutic methods and serve as a consultation resource for physicians in treatment of patients with respiratory conditions.
, Registered Respiratory Therapist
s evaluate and treat patients with a great deal of autonomy under the direction of a pulmonologist, and in specialty facilities respiratory therapists are a preferred addition to surface or air transport. In other settings respiratory therapists are found in schools as asthma educators, working with teachers and coachs about childhood symptoms of asthma and how to spot an emergency. In the United States, legislation has been introduced several times to allow asthma specialist registered respiratory therapists to prescribe and manage previously diagnosed respiratory patients in physician clinics.. In sleep clinics respiratory therapists work with physicians in diagnosis of sleep-related illnesses.
, allowing for the practice and licensure of respiratory care clinicians in those states leaving Alaska as the remaining state not recognizing respiratory care.
The Roman physician Galen
may have been the first to describe mechanical ventilation: "If you take a dead animal and blow air through its larynx [through a reed], you will fill its bronchi and watch its lungs attain the greatest distention." Vesalius
too describes ventilation by inserting a reed or cane into the trachea
of animals. In 1908 George Poe
demonstrated his mechanical respirator by asphyxiating dogs and seemingly bringing them back to life.
Respiratory therapy grew considerably through the twentieth century. There was a time when respiratory therapists were on-the-job trained technicians, with little formal education. Their main function was to ensure safe oxygen use, to administer intermittent positive pressure breathing
(IPPB) treatments, to perform cardiopulmonary resuscitation
(CPR), and to operate negative pressure (iron lung
) ventilators. They were initially titled inhalation therapists. With the advent of positive pressure mechanical ventilators, the more widespread hospital provision of Neonatal and Pediatric care, more sophisticated pulmonary function testing (PFT), a need for thoroughly trained clinical practitioners presented itself. Over the years respiratory therapists have evolved to being college and university trained clinicians who work in a variety of settings.
In 2007 the American Association for Respiratory Care
(AARC) began developing recommendations for the promotion of the field of respiratory care in the United States in response to increased concern regarding licensure and credentialing issues as well as international recognition of those practicing in the United States. The task force decided to recommend that by 2015 the minimum education requirement for licensure and certification as a respiratory therapist be a bachelor of science in respiratory therapy (BSRT). The AARC task force also recommended the American Respiratory Care Foundation
change its scholarship policies and only award assistance and grants to those working toward a bachelors degree. The Committee on Accreditation for Respiratory Care (CoARC) was asked by the AARC task force to change its accreditation standards and no longer accredit associates level respiratory care programs. The CoARC replied by a press release rejecting the recommendation. In 2011 legislation introduced by the AARC will help improve the use of respiratory therapists in clinical applications by allowing them to manage patients suffering from asthma
and COPD seeing a clinic for routine checkups. Similar bills
have been introduced before and has died in committee.
is the most important treatment of most diseases of pulmonology
, usually by inhalation (bronchodilator
s and steroid
s) or also by mouth or IV (antibiotic
s, leukotriene antagonist
s). A common example being the usage of inhalers in the treatment of inflammatory lung conditions such as Asthma
or Chronic obstructive pulmonary disease
(Emphysema
. Oxygen therapy
is often necessary in severe respiratory disease such as pulmonary fibrosis
.
Intensive Care — Mechanical ventilation
may be required in instances of rapidly advancing disease or difficulty after surgery. Different modes of mechanical ventilation
are used for various instances depending on the patients need.
Pulmonary Rehabilitation — Pulmonary rehabilitation
may be initiated as a treatment as a source for continuity of improvement after a hospital stay or as a therapeutic way to increase quality of life. Pulmonary rehabilitation is intended to educate the patient, the family, and improve the overall quality of life and prognosis
for the patient. Pulmonary Rehabilitation involves therapies and evaluations by Respiratory Therapists, Occupational Therapist
s and Physical Therapists.
and Canada
, Respiratory Therapists are therapists who, after receiving a degree in cardiopulmonary science or respiratory science complete a credentialing process. After satisfactorily completing the required examinations and added to a registry, the therapist is then eligible to apply for a license to practice in their respective state or territory. In the United States
, specialist respiratory therapists are clinicians who hold specialized credentials in a specific field of study, such as a Asthma Educator or a Neonatal & Pediatric Transport Specialist.
International respiratory therapy
Internationally respiratory therapists are generally not recognized as a medical clinician though in 2011 hospitals in Beijing, China began a recruitment drive to acquire respiratory therapists for their intensive care units where previously nurses were the only clinician.
(NBRC) which regulates two levels of certification. The Certified Respiratory Therapist
(CRT) and the Registered Respiratory Therapist
(RRT). The CRT is the certification given after successfully passing the entry-level examination NBRC-ELE
; The RRT certification is given after first becoming a CRT and then passing the NBRC-WRE
and NBRC-CSE
.
Most state boards of respiratory care require proof of the appropriate NBRC credential and award various license titles; including (but not limited to) Respiratory Care Practitioner, Licensed Registered Respiratory Therapist, and Licensed Certified Respiratory Therapist. There has been a substantial push to standardize the state licensure by the American Association for Respiratory Care
. The NBRC credential is renewed every 5 years for a fee in addition to fees assessed by the state boards of respiratory care.
, ranging from the anatomy of the respiratory epithelium
to the most effective treatment of pulmonary hypertension
in pediatrics. Scientific research also takes place to look for causes and possible treatment in diseases such as asthma
and lung cancer
.
specialist's work with clinics, hospitals and schools as an educator for teachers and practitioners on asthma and allergies. Respiratory Therapists in the role as an Asthma Educator additionally help diagnose and treat asthma and other respiratory illness. An Asthma Educator is the resource clinician in inpatient and outpatient environments for evaluating and advising physicians on treatment plans and helping facilitate patient understanding and compliance with the plan. In the United States, Certified Asthma Educators (AE-C) are credentialed by the National Asthma Educator Certification Board (NAECB).
in clinics and hospitals by educating them about their disease and working with them on a treatment plan. While admitted to a hospital, patients with cystic fibrosis have their treatment schedule modified and maintained by respiratory therapists. Maintaining a healthy schedule for pharmokonetic and physical therapeutic airway clearance typically more frequent than home treatment plans because admissions are usually due to an increased need for therapy during the stay.
(ECMO) is a modified cardiopulmonary bypass technique used for the treatment of life threatening cardiac or respiratory failure. An ECMO Clinical Specialist is a technical specialist trained to manage the ECMO system including blood pump, tubing, artificial oxygenator, and related equipment. The ECMO Specialist, under qualified medical direction and supervision, is also responsible for the clinical needs of the patient on ECMO which may include bedside management of oxygenation and carbon dioxide removal, maintenance of normal acid-base balance, administration of medications, blood and blood products, and maintenance of appropriate anticoagulation therapies for the blood. This ECMO Clinical Specialist may be the bedside critical care nurse specifically trained in ECMO patient and circuit management, or the ECMO system may be primarily managed by a registered respiratory therapist
, or physicians with training as ECMO clinical specialists .
is a rapidly expanding science and has been recognized as a complex technology by the respiratory therapy credentialing agency (NBRC) who in 2011 added the speciality credential called the "Adult Critical Care Specialist", available only to the registered respiratory therapist
(RRT-ACCS).
(CRT-NPS) and the registered respiratory therapist
(RRT-NPS) however the registered respiratory therapist (RRT-NPS) is preferred by most organizations.
(RRT-SDS) whom performs sleep disorders testing and therapeutic intervention along with diagnosis of sleep related disease such as Obstructive Sleep Apnea
or Central Apnea
. The role is very similar to the Polysomnographic Technologist
.
and ground transport. They are a vital practitioner delivering care inside helicopters, air ambulance or ground ambulance working to pick up a patient and move them to a facility that has what they need. In the United States certification for transport (C-NPT) is currently awarded by The National Certification Corporation. The NREMT has included respiratory therapists as qualifing for the advanced credentialing as a critical care paramedic CCEMT-P.
Clinical practice
Respiratory therapists are found in various sectors of health care. In the hospital setting, respiratory therapists evaluate, treat and assist with diagnosis of respiratory/pulmonary diseases. In the United StatesUnited States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, Registered Respiratory Therapist
Registered Respiratory Therapist
A Registered Respiratory Therapist is a cardiopulmonary therapist and specialist who is required to exercise considerable independent clinical judgment in the respiratory care of patients...
s evaluate and treat patients with a great deal of autonomy under the direction of a pulmonologist, and in specialty facilities respiratory therapists are a preferred addition to surface or air transport. In other settings respiratory therapists are found in schools as asthma educators, working with teachers and coachs about childhood symptoms of asthma and how to spot an emergency. In the United States, legislation has been introduced several times to allow asthma specialist registered respiratory therapists to prescribe and manage previously diagnosed respiratory patients in physician clinics.. In sleep clinics respiratory therapists work with physicians in diagnosis of sleep-related illnesses.
History
Respiratory therapy has existed since around 1950 in the United States. Though just as old as other fields of medicine Respiratory Care is regarded as a young practice and specialty because of the lack of official scope and regulatory structure until the 2000's. In 2004 Vermont became the 48th state and in 2011 Hawaii became the 49th state in the United States to enact a Respiratory Care ActRespiratory Care Act
A Respiratory Care Act is a common term for a law enacted allowing for the practice of Respiratory Care in a given state, province, region or nation...
, allowing for the practice and licensure of respiratory care clinicians in those states leaving Alaska as the remaining state not recognizing respiratory care.
The Roman physician Galen
Galen
Aelius Galenus or Claudius Galenus , better known as Galen of Pergamon , was a prominent Roman physician, surgeon and philosopher...
may have been the first to describe mechanical ventilation: "If you take a dead animal and blow air through its larynx [through a reed], you will fill its bronchi and watch its lungs attain the greatest distention." Vesalius
Vesalius
Andreas Vesalius was a Flemish anatomist, physician, and author of one of the most influential books on human anatomy, De humani corporis fabrica . Vesalius is often referred to as the founder of modern human anatomy. Vesalius is the Latinized form of Andries van Wesel...
too describes ventilation by inserting a reed or cane into the trachea
Vertebrate trachea
In tetrapod anatomy the trachea, or windpipe, is a tube that connects the pharynx or larynx to the lungs, allowing the passage of air. It is lined with pseudostratified ciliated columnar epithelium cells with goblet cells that produce mucus...
of animals. In 1908 George Poe
George Poe
George Poe, Jr. was a pioneer of mechanical ventilation of asphyxiation victims. He was the first person to manufacture nitrous oxide for commercial use in his Trenton, New Jersey company.-Birth:...
demonstrated his mechanical respirator by asphyxiating dogs and seemingly bringing them back to life.
Respiratory therapy grew considerably through the twentieth century. There was a time when respiratory therapists were on-the-job trained technicians, with little formal education. Their main function was to ensure safe oxygen use, to administer intermittent positive pressure breathing
Intermittent positive pressure breathing
Intermittent positive pressure breathing is a respiratory therapy treatment for people who are hypoventilating. While not a preferred method due to cost, IPPB is used to provide expand the lungs, deliver aerosol medications, and in some circumstances ventilate the patient.- Indications :IPPB may...
(IPPB) treatments, to perform cardiopulmonary resuscitation
Cardiopulmonary resuscitation
Cardiopulmonary resuscitation is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive...
(CPR), and to operate negative pressure (iron lung
Iron lung
A negative pressure ventilator is a form of medical ventilator that enables a person to breathe when normal muscle control has been lost or the work of breathing exceeds the person's ability....
) ventilators. They were initially titled inhalation therapists. With the advent of positive pressure mechanical ventilators, the more widespread hospital provision of Neonatal and Pediatric care, more sophisticated pulmonary function testing (PFT), a need for thoroughly trained clinical practitioners presented itself. Over the years respiratory therapists have evolved to being college and university trained clinicians who work in a variety of settings.
In 2007 the American Association for Respiratory Care
American Association for Respiratory Care
The American Association for Respiratory Care is a non profit organization and is currently the only professional organization supporting Respiratory Care in the United States. In addition to attempting to help lobby for beneficial legislation nationally and locally, the AARC is trying to promote...
(AARC) began developing recommendations for the promotion of the field of respiratory care in the United States in response to increased concern regarding licensure and credentialing issues as well as international recognition of those practicing in the United States. The task force decided to recommend that by 2015 the minimum education requirement for licensure and certification as a respiratory therapist be a bachelor of science in respiratory therapy (BSRT). The AARC task force also recommended the American Respiratory Care Foundation
American Respiratory Care Foundation
The American Respiratory Care Foundation is a non-profit organization founded by the American Association for Respiratory Care formed to provide funding for research in the field of pulmonology and respiratory care. Formed in 1974 as the American Respiratory Therapy Foundation and then changed to...
change its scholarship policies and only award assistance and grants to those working toward a bachelors degree. The Committee on Accreditation for Respiratory Care (CoARC) was asked by the AARC task force to change its accreditation standards and no longer accredit associates level respiratory care programs. The CoARC replied by a press release rejecting the recommendation. In 2011 legislation introduced by the AARC will help improve the use of respiratory therapists in clinical applications by allowing them to manage patients suffering from asthma
Asthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
and COPD seeing a clinic for routine checkups. Similar bills
Respiratory Care Act
A Respiratory Care Act is a common term for a law enacted allowing for the practice of Respiratory Care in a given state, province, region or nation...
have been introduced before and has died in committee.
Treatment
Medication — MedicationMedication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
is the most important treatment of most diseases of pulmonology
Pulmonology
In medicine, pulmonology is the specialty that deals with diseases of the respiratory tract and respiratory disease. It is called chest medicine and respiratory medicine in some countries and areas...
, usually by inhalation (bronchodilator
Bronchodilator
A bronchodilator is a substance that dilates the bronchi and bronchioles, decreasing resistance in the respiratory airway and increasing airflow to the lungs. Bronchodilators may be endogenous , or they may be medications administered for the treatment of breathing difficulties...
s and steroid
Steroid
A steroid is a type of organic compound that contains a characteristic arrangement of four cycloalkane rings that are joined to each other. Examples of steroids include the dietary fat cholesterol, the sex hormones estradiol and testosterone, and the anti-inflammatory drug dexamethasone.The core...
s) or also by mouth or IV (antibiotic
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
s, leukotriene antagonist
Leukotriene antagonist
A leukotriene antagonist is a drug that inhibits leukotrienes, which are fatty compounds produced by the immune system that cause inflammation in asthma and bronchitis, and constrict airways....
s). A common example being the usage of inhalers in the treatment of inflammatory lung conditions such as Asthma
Asthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
or Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease , also known as chronic obstructive lung disease , chronic obstructive airway disease , chronic airflow limitation and chronic obstructive respiratory disease , is the co-occurrence of chronic bronchitis and emphysema, a pair of commonly co-existing diseases...
(Emphysema
Emphysema
Emphysema is a long-term, progressive disease of the lungs that primarily causes shortness of breath. In people with emphysema, the tissues necessary to support the physical shape and function of the lungs are destroyed. It is included in a group of diseases called chronic obstructive pulmonary...
. Oxygen therapy
Oxygen therapy
Oxygen therapy is the administration of oxygen as a medical intervention, which can be for a variety of purposes in both chronic and acute patient care...
is often necessary in severe respiratory disease such as pulmonary fibrosis
Pulmonary fibrosis
Pulmonary fibrosis is the formation or development of excess fibrous connective tissue in the lungs. It is also described as "scarring of the lung".-Symptoms:Symptoms of pulmonary fibrosis are mainly:...
.
Intensive Care — Mechanical ventilation
Mechanical ventilation
In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing. This may involve a machine called a ventilator or the breathing may be assisted by a physician, respiratory therapist or other suitable person compressing a bag or set of bellows...
may be required in instances of rapidly advancing disease or difficulty after surgery. Different modes of mechanical ventilation
Modes of mechanical ventilation
Modes of mechanical ventilation are one of the most important aspects of the usage of mechanical ventilation. The mode refers to the method of inspiratory support. Mode selection is generally based on clinician familiarity and institutional preferences since there is a paucity of evidence...
are used for various instances depending on the patients need.
Pulmonary Rehabilitation — Pulmonary rehabilitation
Pulmonary rehabilitation
Pulmonary rehabilitation refers to a series of services that are administered to patients of respiratory disease and their families, typically to attempt to improve the quality of life for the patient...
may be initiated as a treatment as a source for continuity of improvement after a hospital stay or as a therapeutic way to increase quality of life. Pulmonary rehabilitation is intended to educate the patient, the family, and improve the overall quality of life and prognosis
Prognosis
Prognosis is a medical term to describe the likely outcome of an illness.When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because...
for the patient. Pulmonary Rehabilitation involves therapies and evaluations by Respiratory Therapists, Occupational Therapist
Occupational therapist
An occupational therapist is trained in the practice of occupational therapy. The role of an occupational therapist is to work with a client to help them achieve a fulfilled and satisfied state in life through the use of "purposeful activity or interventions designed to achieve functional...
s and Physical Therapists.
Respiratory therapy as a career
In the United StatesUnited States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
and Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
, Respiratory Therapists are therapists who, after receiving a degree in cardiopulmonary science or respiratory science complete a credentialing process. After satisfactorily completing the required examinations and added to a registry, the therapist is then eligible to apply for a license to practice in their respective state or territory. In the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, specialist respiratory therapists are clinicians who hold specialized credentials in a specific field of study, such as a Asthma Educator or a Neonatal & Pediatric Transport Specialist.
International respiratory therapy
Internationally respiratory therapists are generally not recognized as a medical clinician though in 2011 hospitals in Beijing, China began a recruitment drive to acquire respiratory therapists for their intensive care units where previously nurses were the only clinician.
Credentialing in the United States
In the United States there are two separate credentialing bodies. One is the State Board of Respiratory Care in the state in which a respiratory therapist is licensed to practice and the other is the National Board for Respiratory CareNational Board for Respiratory Care
The National Board for Respiratory Care Inc. is a non-profit organization formed in 1986 with the purpose of awarding and maintaining credentialing for Respiratory therapists in the United States....
(NBRC) which regulates two levels of certification. The Certified Respiratory Therapist
Certified Respiratory Therapist
A Certified Respiratory Therapist , formerly Certified Respiratory Therapy Technician , is a therapist who has graduated from a respiratory therapy program at a university or college and has passed a national certification exam...
(CRT) and the Registered Respiratory Therapist
Registered Respiratory Therapist
A Registered Respiratory Therapist is a cardiopulmonary therapist and specialist who is required to exercise considerable independent clinical judgment in the respiratory care of patients...
(RRT). The CRT is the certification given after successfully passing the entry-level examination NBRC-ELE
NBRC-ELE
NBRC-ELE is an examination for the certification credential of respiratory therapists in the United States...
; The RRT certification is given after first becoming a CRT and then passing the NBRC-WRE
NBRC-WRE
The NBRC-WRE is an examination for the advanced credentialing of previously certified respiratory therapists in the United States....
and NBRC-CSE
NBRC-CSE
NBRC-CSE is an examination for the advanced credentialing of respiratory therapists in the United States....
.
Most state boards of respiratory care require proof of the appropriate NBRC credential and award various license titles; including (but not limited to) Respiratory Care Practitioner, Licensed Registered Respiratory Therapist, and Licensed Certified Respiratory Therapist. There has been a substantial push to standardize the state licensure by the American Association for Respiratory Care
American Association for Respiratory Care
The American Association for Respiratory Care is a non profit organization and is currently the only professional organization supporting Respiratory Care in the United States. In addition to attempting to help lobby for beneficial legislation nationally and locally, the AARC is trying to promote...
. The NBRC credential is renewed every 5 years for a fee in addition to fees assessed by the state boards of respiratory care.
Scientific research
Respiratory scientists are specialists in pulmonary function. Respiratory therapists work with Pulmonologists in both clinical and general research of the respiratory systemRespiratory system
The respiratory system is the anatomical system of an organism that introduces respiratory gases to the interior and performs gas exchange. In humans and other mammals, the anatomical features of the respiratory system include airways, lungs, and the respiratory muscles...
, ranging from the anatomy of the respiratory epithelium
Respiratory epithelium
Respiratory epithelium is a type of epithelium found lining the respiratory tract, where it serves to moisten and protect the airways. It also functions as a barrier to potential pathogens and foreign particles, preventing infection and tissue injury by action of the mucociliary escalator.-...
to the most effective treatment of pulmonary hypertension
Pulmonary hypertension
In medicine, pulmonary hypertension is an increase in blood pressure in the pulmonary artery, pulmonary vein, or pulmonary capillaries, together known as the lung vasculature, leading to shortness of breath, dizziness, fainting, and other symptoms, all of which are exacerbated by exertion...
in pediatrics. Scientific research also takes place to look for causes and possible treatment in diseases such as asthma
Asthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
and lung cancer
Lung cancer
Lung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary...
.
Asthma
AsthmaAsthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
specialist's work with clinics, hospitals and schools as an educator for teachers and practitioners on asthma and allergies. Respiratory Therapists in the role as an Asthma Educator additionally help diagnose and treat asthma and other respiratory illness. An Asthma Educator is the resource clinician in inpatient and outpatient environments for evaluating and advising physicians on treatment plans and helping facilitate patient understanding and compliance with the plan. In the United States, Certified Asthma Educators (AE-C) are credentialed by the National Asthma Educator Certification Board (NAECB).
Cystic fibrosis
Respiratory Therapists work with people suffering from cystic fibrosisCystic fibrosis
Cystic fibrosis is a recessive genetic disease affecting most critically the lungs, and also the pancreas, liver, and intestine...
in clinics and hospitals by educating them about their disease and working with them on a treatment plan. While admitted to a hospital, patients with cystic fibrosis have their treatment schedule modified and maintained by respiratory therapists. Maintaining a healthy schedule for pharmokonetic and physical therapeutic airway clearance typically more frequent than home treatment plans because admissions are usually due to an increased need for therapy during the stay.
Extracorporeal Membrane Oxygenation (ECMO)
Extracorporeal membrane oxygenationExtracorporeal membrane oxygenation
In intensive care medicine, extracorporeal membrane oxygenation is an extracorporeal technique of providing both cardiac and respiratory support oxygen to patients whose heart and lungs are so severely diseased or damaged that they can no longer serve their function...
(ECMO) is a modified cardiopulmonary bypass technique used for the treatment of life threatening cardiac or respiratory failure. An ECMO Clinical Specialist is a technical specialist trained to manage the ECMO system including blood pump, tubing, artificial oxygenator, and related equipment. The ECMO Specialist, under qualified medical direction and supervision, is also responsible for the clinical needs of the patient on ECMO which may include bedside management of oxygenation and carbon dioxide removal, maintenance of normal acid-base balance, administration of medications, blood and blood products, and maintenance of appropriate anticoagulation therapies for the blood. This ECMO Clinical Specialist may be the bedside critical care nurse specifically trained in ECMO patient and circuit management, or the ECMO system may be primarily managed by a registered respiratory therapist
Registered Respiratory Therapist
A Registered Respiratory Therapist is a cardiopulmonary therapist and specialist who is required to exercise considerable independent clinical judgment in the respiratory care of patients...
, or physicians with training as ECMO clinical specialists .
Intensive care
Intensive Care is one of the mainstays of respiratory therapy. Respiratory Therapists are taking an increased clinical role in recent years related to intensive care. Ventilatory support is usually the largest criteria for being placed into an intensive care setting which is maintained entirely by Respiratory Therapists and Cardiopulmonary specialists. Mechanical VentilationMechanical ventilation
In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing. This may involve a machine called a ventilator or the breathing may be assisted by a physician, respiratory therapist or other suitable person compressing a bag or set of bellows...
is a rapidly expanding science and has been recognized as a complex technology by the respiratory therapy credentialing agency (NBRC) who in 2011 added the speciality credential called the "Adult Critical Care Specialist", available only to the registered respiratory therapist
Registered Respiratory Therapist
A Registered Respiratory Therapist is a cardiopulmonary therapist and specialist who is required to exercise considerable independent clinical judgment in the respiratory care of patients...
(RRT-ACCS).
Neonatal & Pediatric Intensive Care
Much like adult intensivist therapists neonatal and pediatric specialists deal primarily with monitoring ventilation and perfusion. The NPS practitioner is trained extensively in antenatal and intrapartum patients and family. Neonatal assessment and laboratory studies. The practitioner is also a specialist in ventilatory support and cardio-pulmonary therapy of neonatal and pediatric patients. In the United States NPS credentialing is available to both the certified respiratory therapistCertified Respiratory Therapist
A Certified Respiratory Therapist , formerly Certified Respiratory Therapy Technician , is a therapist who has graduated from a respiratory therapy program at a university or college and has passed a national certification exam...
(CRT-NPS) and the registered respiratory therapist
Registered Respiratory Therapist
A Registered Respiratory Therapist is a cardiopulmonary therapist and specialist who is required to exercise considerable independent clinical judgment in the respiratory care of patients...
(RRT-NPS) however the registered respiratory therapist (RRT-NPS) is preferred by most organizations.
Sleep Disorder Specialist
The Sleep Disorder Specialist is a Registered Respiratory TherapistRegistered Respiratory Therapist
A Registered Respiratory Therapist is a cardiopulmonary therapist and specialist who is required to exercise considerable independent clinical judgment in the respiratory care of patients...
(RRT-SDS) whom performs sleep disorders testing and therapeutic intervention along with diagnosis of sleep related disease such as Obstructive Sleep Apnea
Obstructive sleep apnea
Obstructive sleep apnea or obstructive sleep apnea syndrome is the most common type of sleep apnea and is caused by obstruction of the upper airway. It is characterized by repetitive pauses in breathing during sleep, despite the effort to breathe, and is usually associated with a reduction in...
or Central Apnea
Central sleep apnea
Central sleep apnea or central sleep apnea syndrome is a sleep-related disorder in which the effort to breathe is diminished or absent, typically for 10 to 30 seconds, either intermittently or in cycles and is usually associated with a reduction in blood oxygen saturation...
. The role is very similar to the Polysomnographic Technologist
Polysomnographic technologist
A polysomnographic technologist performs overnight polysomnograms on those with suspected sleep disorders. In the United States and worldwide the process for becoming a polysomnography technician or technologist is primarily either on-the-job or certificate based...
.
Case Management
Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's health and human services needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes. Eligibility and certification is maintained by the Commission for Case Management Certification, a body certifying healthcare professionals in the United States.Surface & Air Transport
Respiratory therapists work with nurses, physicians, and paramedics in emergency flightAir medical services
Air medical services is a comprehensive term covering the use of air transportation to move patients to and from healthcare facilities to improve their level of care...
and ground transport. They are a vital practitioner delivering care inside helicopters, air ambulance or ground ambulance working to pick up a patient and move them to a facility that has what they need. In the United States certification for transport (C-NPT) is currently awarded by The National Certification Corporation. The NREMT has included respiratory therapists as qualifing for the advanced credentialing as a critical care paramedic CCEMT-P.
See also
- Respiratory Care Associations — Internationally registered nurses fulfill the role of the registered respiratory therapistRegistered Respiratory TherapistA Registered Respiratory Therapist is a cardiopulmonary therapist and specialist who is required to exercise considerable independent clinical judgment in the respiratory care of patients...
and so many organizations focus on nursing in relation to pulmonary care. - Registered Respiratory TherapistRegistered Respiratory TherapistA Registered Respiratory Therapist is a cardiopulmonary therapist and specialist who is required to exercise considerable independent clinical judgment in the respiratory care of patients...
— Becoming more prominent is the advanced practice respiratory therapist. - Certified Respiratory TherapistCertified Respiratory TherapistA Certified Respiratory Therapist , formerly Certified Respiratory Therapy Technician , is a therapist who has graduated from a respiratory therapy program at a university or college and has passed a national certification exam...
— Formerly called a technician, this is the entry level therapist credential. - American Association of Respiratory Care — The AARC is the only professional association for Respiratory Therapists in the United States.
- National Board for Respiratory CareNational Board for Respiratory CareThe National Board for Respiratory Care Inc. is a non-profit organization formed in 1986 with the purpose of awarding and maintaining credentialing for Respiratory therapists in the United States....
— The NBRC is a non-profit credentialing agency keeping a registry of therapists in the United States and Latin America. - Canadian Society of Respiratory TherapistsCanadian Society of Respiratory TherapistsThe Canadian Society of Respiratory Therapists was founded in 1964 as the Canadian Society of Inhalation Therapy Technicians. Currently is the Canadian national professional association for respiratory therapists.-Education and credentialing:...
– The national professional association for respiratory therapists in Canada.