Respiratory therapists and respiratory therapy technicians—also known as respiratory care practitioners—evaluate, treat, and care for patients with breathing or other cardiopulmonary disorders. Practicing under the direction of a physician, respiratory therapists assume primary responsibility for all respiratory care therapeutic treatments and diagnostic procedures, including the supervision of respiratory therapy technicians. Respiratory therapy technicians follow specific, well-defined respiratory care procedures under the direction of respiratory therapists and physicians.
In clinical practice, many of the daily duties of therapists and technicians overlap. However, therapists generally have greater responsibility than technicians. For example, respiratory therapists consult with physicians and other health care staff to help develop and modify patient care plans. Respiratory therapists also are more likely to provide complex therapy requiring considerable independent judgment, such as caring for patients on life support in intensive-care units of hospitals. In this Handbook statement, the term respiratory therapist includes both respiratory therapists and respiratory therapy technicians.
Respiratory therapists evaluate and treat all types of patients, ranging from premature infants whose lungs are not fully developed to elderly people whose lungs are diseased. Respiratory therapists provide temporary relief to patients with chronic asthma or emphysema, and they give emergency care to patients who are victims of a heart attack, stroke, drowning, or shock.
To evaluate patients, respiratory therapists interview them, perform limited physical examinations, and conduct diagnostic tests. For example, respiratory therapists test a patient's breathing capacity and determine the concentration of oxygen and other gases in a patient's blood. They also measure a patient's pH, which indicates the acidity or alkalinity of the blood. To evaluate a patient's lung capacity, respiratory therapists have the patient breathe into an instrument that measures the volume and flow of oxygen during inhalation and exhalation. By comparing the reading with the norm for the patient's age, height, weight, and sex, respiratory therapists can provide information that helps determine whether the patient has any lung deficiencies. To analyze oxygen, carbon dioxide, and blood pH levels, therapists draw an arterial blood sample, place it in a blood gas analyzer, and relay the results to a physician, who then makes treatment decisions.
To treat patients, respiratory therapists use oxygen or oxygen mixtures, chest physiotherapy, and aerosol medications—liquid medications suspended in a gas that forms a mist which is inhaled. They teach patients how to inhale the aerosol properly to ensure its effectiveness. When a patient has difficulty getting enough oxygen into his or her blood, therapists increase the patient's concentration of oxygen by placing an oxygen mask or nasal cannula on the patient and setting the oxygen flow at the level prescribed by a physician. Therapists also connect patients who cannot breathe on their own to ventilators that deliver pressurized oxygen into the lungs. The therapists insert a tube into the patient's trachea, or windpipe; connect the tube to the ventilator; and set the rate, volume, and oxygen concentration of the oxygen mixture entering the patient's lungs.
Therapists perform regular assessments of patients and equipment. If a patient appears to be having difficulty breathing or if the oxygen, carbon dioxide, or pH level of the blood is abnormal, therapists change the ventilator setting according to the doctor's orders or check the equipment for mechanical problems.
Respiratory therapists perform chest physiotherapy on patients to remove mucus from their lungs and make it easier for them to breathe. Therapists place patients in positions that help drain mucus, and then vibrate the patients' rib cages, often by tapping on the chest, and tell the patients to cough. Chest physiotherapy may be needed after surgery, for example, because anesthesia depresses respiration. As a result, physiotherapy may be prescribed to help get the patient's lungs back to normal and to prevent congestion. Chest physiotherapy also helps patients suffering from lung diseases, such as cystic fibrosis, that cause mucus to collect in the lungs.
Therapists who work in home care teach patients and their families to use ventilators and other life-support systems. In addition, these therapists visit patients in their homes to inspect and clean equipment, evaluate the home environment, and ensure that patients have sufficient knowledge of their diseases and the proper use of their medications and equipment. Therapists also make emergency visits if equipment problems arise.
In some hospitals, therapists perform tasks that fall outside their traditional role. Therapists are becoming involved in areas such as pulmonary rehabilitation, smoking cessation counseling, disease prevention, case management, and polysomnography—the diagnosis of breathing disorders during sleep, such as apnea. Respiratory therapists also increasingly treat critical care patients, either as part of surface and air transport teams or as part of rapid-response teams in hospitals.
Work environment. Respiratory therapists generally work between 35 and 40 hours a week. Because hospitals operate around the clock, therapists may work evenings, nights, or weekends. They spend long periods standing and walking between patients' rooms. In an emergency, therapists work under the stress of the situation. Respiratory therapists employed in home health care must travel frequently to patients' homes.
Respiratory therapists are trained to work with gases stored under pressure. Adherence to safety precautions and regular maintenance and testing of equipment minimize the risk of injury. As in many other health occupations, respiratory therapists are exposed to infectious diseases, but by carefully following proper procedures they can minimize the risks.
| 1. | Use ventilators and various oxygen devices and aerosol and breathing treatments in the provision of respiratory therapy. |
| 2. | Work with patients in areas such as the emergency room, neonatal or pediatric intensive care, and surgical intensive care, treating conditions including emphysema, chronic bronchitis, asthma, cystic fibrosis, and pneumonia. |
| 3. | Read and evaluate physicians' orders and patients' chart information to determine patients' condition and treatment protocols. |
| 4. | Keep records of patients' therapy, completing all necessary forms. |
| 5. | Set equipment controls to regulate the flow of oxygen, gases, mists, or aerosols. |
| 6. | Provide respiratory care involving the application of well-defined therapeutic techniques under the supervision of a respiratory therapist and a physician. |
| 7. | Assess patients' response to treatments and modify treatments according to protocol if necessary. |
| 8. | Prepare and test devices such as mechanical ventilators, therapeutic gas administration apparatus, environmental control systems, aerosol generators and electrocardiogram (EKG) machines. |
| 9. | Monitor patients during treatment and report any unusual reactions to the respiratory therapist. |
| 10. | Explain treatment procedures to patients. |
| 11. | Clean, sterilize, check and maintain respiratory therapy equipment. |
| 12. | Perform diagnostic procedures to assess the severity of respiratory dysfunction in patients. |
| 13. | Follow and enforce safety rules applying to equipment. |
| 14. | Administer breathing and oxygen procedures such as intermittent positive pressure breathing treatments, ultrasonic nebulizer treatments and incentive spirometer treatments. |
| 15. | Recommend and review bedside procedures, x-rays, and laboratory tests. |
| 16. | Interview and examine patients to collect clinical data. |
| 17. | Teach patients how to use respiratory equipment at home. |
| 18. | Teach or oversee other workers who provide respiratory care services. |
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