Respiratory therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Respiratory therapy is categorized as an allied health profession in the United States and Canada. Respiratory therapists (RTs), also known as Respiratory Care Practitioners (RCP), specialize in the assessment and treatment of respiratory and cardiovascular pathologies. These include chronic lung problems (e.g., asthma, bronchitis, emphysema, COPD), and more acute multi-systemic problems stemming from other pathological conditions such as heart attacks, stroke, or trauma as well as complications at birth. RTs are specialists in airway management, mechanical ventilation, blood acid/base balance, and critical care medicine. RTs work closely with other medical disciplines such as physicians, nurses, speech therapists and physical therapists etc.


Respiratory Therapy has grown considerably through the past four decades. There was a time when Respiratory therapists were on the job trained techs, with little formal education. Their main function was to ensure safe oxygen use. With the advent of Mechanical Ventilators, modern CPR and airway care methods, a need for thoroughly trained practitioners presented itself. Over the years "techs" have evolved to college trained therapists who practice in a variety of settings.

Certification, Education, and Training

Registered Respiratory Therapists (RRT) are required to complete a minimum of a two-year associate degree program. There are also three-, four- and five-year degree programs. There are also Master's and PhD degree programs offered by some schools. After graduation, the therapist must then write a national exam administered by the Canadian Board of Respiratory Care (CBRC) in Canada and/or the National Board for Respiratory Care (NBRC) in the United States. In the US, a two tiered system exists. First a certification exam can be taken, and if passed, the therapist is designated CRT, or certified respiratory therapist. After that, a registry exam can be taken giving the designation of RRT, or registered respiratory therapist. Also, further examination for Neonatal/Pediatric specialist may be taken allowing RT's to be designated as neonatal-pediatric specialists, CRT-NPS or RRT-NPS.

In order to be considered for admission to a respiratory therapy program, a strong high school background (typically grades of B+ or higher) in science and math at the senior matriculation level is usually required. The program of study varies from one school to another, but all programs include the following:

Courses in anatomy, physiology, pathophysiology, pharmacology, chemistry, physics, microbiology, hemodynamics, mechanical ventilation, statistics, healthcare law, and medical ethics are required. Pass marks are usually set high. These studies relate to all body systems. Extra focus is spent on the respiratory, cardiovascular, neurological and renal systems.

Class sizes are usually small and offer classroom as well as clinical "hands-on" experiences. Many applicants already hold science degrees. Traditionally there is a measurable attrition rate due to a student's failure to meet expected performance standards. Most of the schools do not allow multiple rewrites of failed exams. The material from the entire program must be mastered, applied and retained. There is no "cook book" practice. RTs must think quickly under stressful situations and make the proper life-or-death decisions. RTs function as a patient advocate, as well as a staff, physician and patient resource. RTs function as a member of the health care team.

Roles and Responsibilities

Airway management is a number-one skill needed by a respiratory therapist as well as vascular access for intravenous lines (IV), an arterial line or arterial blood gas (ABG). They are an essential part of the Code Blue (Cardiac Arrest) team. Some RTs are specially trained in helping in the operating room (OR), high-risk deliveries, extracorporeal membrane oxygenation (ECMO), chest tube and central line insertion. RRTs may also provide an important role in the homecare environment. Here the RRT's role is different from the hospital role in that there are not a lot of available technical resources available. One must rely more on clinical assessments and experience-related decision-making when evaluating the patient's current condition. This is where the real extent of the RRT's knowledge is truly tested.

The nature of the RT's education allows for easy upgrading to learn more advanced skills and procedures. Respiratory therapists only act on a physician's order, except where there are written protocols or, in the event of an emergency, with no physician present. An example of an existing protocol: Duke University Medical Center utlizes RTs to provide all, out-of-operating-room intubations. In Ontario, Canada, RTs intubate at in-hospital Cardiac Arrests and most hospitals allow RTs to ventilate a patient based on their interpretations of blood gasses, allowing them to treat patients based on their knowledge and training. Physicians may write an order, "to ventilate according to Respiratory Therapist," or, "Adjust Ventilator" to maintain certain physiological values. These types of orders require the therapist to interpret lab results and assess the patient, then make a decision to adjust or not to adjust life support parameters. As one can see, the wrong choice could result in serious harm or death to the patient. The therapist must be educated and trained well in order to safely complete these tasks. Therapist also conduct medical research projects as well.

Regulatory Bodies and Professional Societies in the United States

In the United States respiratory therapy is regulated by the individual states. Some states require licensure by the individual state, others accept the accreditation granted by the NBRC [2]. The American Association for Respiratory Care [3] is only professional organization in the United States specifically for respiratory care providers.

Remuneration in Canada

Starting salaries in Canada for a staff RRT range from $40,000 in Prince Edward Island to $65,000 in Alberta. The top-end yearly salary of an RRT staff position in Alberta, Canada is $75,000.00. Typically, RTs are entitled to four weeks of vacation after one year plus 11 statutory holidays and can supplement their salaries with overtime work and continuing education.

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