Cartoon of clinician ascultating a patient. |
|
| Occupation | |
|---|---|
| Names |
|
| Activity sectors | Medicine, Allied Health |
| Description | |
| Education required | |
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 Practitioners in most places internationally but may also be referred to as Respiratory Scientists or Respiratory Therapists. Respiratory practitioners work independently and as part of a team to plan, integrate, and evaluate cardiac and pulmonary care. Respiratory practitioners also recommend intervention and therapeutic methods and serve as a consultation resource for physicians in treatment of patients with respiratory conditions.[1] In the United States oxygen and other medical gas systems, both portable and installed are under the management of the department of Respiratory Care and subsequently by the Respiratory Practitioners within that hospital.
Contents |
Respiratory practitioners are found in various sectors of health care. In the hospital setting, Respiratory practitioners evaluate, treat and assist with diagnosis of respiratory/pulmonary diseases. In the United States, Respiratory practitioners with certification as Registered Respiratory Therapists evaluate and treat patients with a great deal of autonomy under the direction of a pulmonologist,[2] and in specialty facilities respiratory therapists are a preferred addition to surface or air transport.[3] 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 Respiratory practitioners certified as asthma specialists with registered respiratory therapist certification to prescribe and manage previously diagnosed respiratory patients in physician clinics.[4][5] In sleep clinics respiratory practitioners work with physicians in diagnosis of sleep-related illnesses. Respiratory practitioners in the United States are migrating toward a mid-level (or physician extender) role similar to the physician assistant or nurse practitioner.[6]
Respiratory therapy has existed since around 1950 in the United States.[7] 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 2000s. In 2004 Vermont became the 48th state and in 2011 Hawaii became the 49th [8] state in the United States to enact a Respiratory Care Act, 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."[9] Vesalius too describes ventilation by inserting a reed or cane into the trachea of animals.[10] In 1908 George Poe demonstrated his mechanical respirator by asphyxiating dogs and seemingly bringing them back to life.[11]
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[7] in response to increased concern regarding licensure and credentialing issues as well as international recognition of those practicing in the United States.[6] 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).[12] 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.[12] The CoARC replied by a press release rejecting the recommendation.[13] 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.[14] Similar bills have been introduced before and have died in committee.[4][5][15]
Medication — Medication is the most important treatment of most diseases of pulmonology, usually by inhalation (bronchodilators and steroids) or also by mouth or IV (antibiotics, leukotriene antagonists). 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 Practitioners, Occupational Therapists and Physical Therapists.
In the United States 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.
Internationally respiratory therapists are generally not recognized as medical clinicians. In 2011, however, hospitals in Beijing, China began a recruitment drive to acquire respiratory therapists for their intensive care units where previously nurses were the only clinician.[16]
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 Practitioner is licensed to practice and the other is the National Board for Respiratory Care (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.[7] The NBRC credential is renewed every 5 years for a fee in addition to fees assessed by the state boards of respiratory care.
Respiratory Practitioners are eligible once licensed to take advanced provider courses offered by certification bodies, such as Pediatric Advanced Life Support, Advanced Cardiovascular Life Support, and Advanced Trauma Life Support as a member of the trauma management team.
Respiratory scientists are specialists in pulmonary function.[17] Respiratory therapists work with Pulmonologists in both clinical and general research of the respiratory system, 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.[18]
Asthma specialist's work with clinics, hospitals and schools as an educator for teachers and practitioners on asthma and allergies. Respiratory Practitioners in the role as an Asthma Educator additionally help diagnose and treat asthma and other respiratory illness.[19] 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).[20]
Respiratory Practitioners work with people suffering from cystic fibrosis in clinics and hospitals[21] 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 Practitioners. 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.
Respiratory practitioners are able to fullfill the role of Perfusionist with appropriate training. The perfusionist is a highly trained member of the cardiothoracic surgical team which consists of cardiac surgeons, anesthesiologists, physician assistants, surgical technicians, other respiratory practitioners, and nurses. The perfusionist's main responsibility is to support the physiological and metabolic needs of the cardiac surgical patient so that the cardiac surgeon may operate on a still, unbeating heart. Perfusionist certifications are maintained and awarded by The American Academy of Cardiovascular Perfusion.[22]
Extracorporeal membrane oxygenation (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.[23][24] This ECMO Clinical Specialist may be the bedside critical care nurse specifically trained in ECMO patient and circuit management,[25] or the ECMO system may be primarily managed by a registered respiratory therapist,[26] or physicians with training as ECMO clinical specialists.[25]
Intensive Care is one of the mainstays of respiratory therapy. Respiratory Practitioners 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 Practitioners and Cardiopulmonary specialists. Mechanical Ventilation 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).[27]
Much like adult intensivist Practitioners neonatal and pediatric specialists deal primarily with monitoring ventilation and perfusion.[28] 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.[28] In the United States NPS credentialing is available to both the certified respiratory therapist (CRT-NPS) and the registered respiratory therapist (RRT-NPS) however the registered respiratory therapist (RRT-NPS) is preferred by most organizations.[28][29][30]
The Sleep Disorder Specialist is a Registered Respiratory Therapist (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.
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.[31]
Respiratory Practitioners work with nurses, physicians, and paramedics in emergency flight and ground transport.[32] 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.[33] The NREMT has included Respiratory Practitioners as qualifing for the advanced credentialing as a critical care paramedic CCEMT-P.
|
|||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
