Respiratory Therapy

Respiratory therapy is a healthcare profession in which specialists work with patients suffering from either acute or chronic cardiac and respiratory disease. 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. 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. A respiratory practitioner is a clinician working along side physicians, nurses, pharmacists and other members of the medical team providing direct patient care. In most parts of the world a respiratory practitioner must have a degree in cardiopulmonary medicine or respiratory care and may be required to hold an appropriate license to practice. However, in some countries a registered nurse or physical therapist may be minimally trained to provide respiratory care.

​Clinical practice
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, In facilities that maintain critical care transport teams respiratory practitioners are a preferred addition to all types of surface or air transport. In other settings respiratory therapists are found in schools as asthma educators, working with teachers and coaches 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. In sleep clinics respiratory practitioners work with physicians in diagnosis of sleep-related illnesses. Respiratory practitioners in the United States are migrating toward a role of autonomy similar to the nurse practitioner or as a physician extender (mid-level) like the physician assistant.

Treatment
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. Respiratory practitioners are frequently required to intubate, initiate intravenous lines, place arterial lines as well as many other vascular accesses such as central venous catheters and pulmonary artery catheters (Swan-Ganz).

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.

Careers in respiratory careAsthma educationAsthma specialists work with clinics, hospitals and schools as an educator for teachers, parents, patients 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. Additionally, 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 Canada, the Canadian Network for Asthma Care (now known as the Canadian Network for Respiratory Care) administers two certifications to this end: the Certified Asthma Educator (CAE) (preferred by practitioners with a pediatric focus) and the Certified Respiratory Educator (CRE), which comprises the CAE program with additional training in COPD.

Cystic fibrosis Respiratory practitioners work with people suffering from cystic fibrosis 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 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.

Cardiovascular perfusionist
Respiratory practitioners are able to fulfill 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

TheAmerican Academy of Cardiovascular Perfusion.
Extra-corporeal membrane oxygenation (ECMO)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. 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.

Intensive careIntensive 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 those respiratory practitioners certified as registered respiratory therapists(RRT-ACCS).

Neonatal & pediatric intensive care
Much like adult intensivist Practitioners 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 therapist (CRT-NPS) and the registered respiratory therapist (RRT-NPS) however the registered respiratory therapist (RRT-NPS) is preferred by most organizations.

Sleep disorder specialist
Respiratory practitioners monitor and interpret findings from a sleep study, as well as the medical history and physical exam to make the diagnosis and decide on treatment related to sleep-disorders. A sleep study can also help diagnose narcolepsy. In the United States a sleep disorder specialist can be a Registered Respiratory Therapist with the sleep disorder specialist certification (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
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 Practitioners work with nurses, physicians, and paramedics in emergency flight 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 Practitioners as qualifing for the advanced credentialing as a critical care paramedic CCEMT-P.

Pulmonary research and scienceRespiratory scientists are specialists in pulmonary function. Respiratory practitioners 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

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