RESPIRATORY THERAPY GUIDE

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Learn what Respiratory Therapist job roles entail, find Respiratory Therapy Jobs, and discover resources and books for the Respiratory Therapy profession.

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Respiratory Therapist Job and Responsibilities

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 therapists 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. Respiratory therapists follow specific, well-defined respiratory care procedures under the direction of physicians. There are specific education and training requirements to be a Respiratory Therapist. Respiratory therapists generally have great responsibility in patient care. For example, respiratory therapists will consult with physicians and other health care staff to help develop and modify individual 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.

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. 

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, as well as 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 patients’ breathing capacity and determine the concentration of oxygen and other gases in patients’ blood. They also measure patients’ 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 pH levels, therapists draw an arterial blood sample, place it in a blood gas analyzer, and relay the results to a physician, who then may make treatment decisions.

To treat patients, respiratory therapists use oxygen or oxygen mixtures, chest physiotherapy, and aerosol medications. 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 set 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 the 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. In home care, therapists teach patients and their families to use ventilators and other life-support systems. In addition, therapists visit patients several times a month to inspect and clean equipment and to ensure its proper use. Therapists also make emergency visits if equipment problems arise.

Respiratory therapists perform chest physiotherapy on patients to remove mucus from their lungs and make it easier for them to breathe. For example, during surgery, anesthesia depresses respiration, so chest 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 place patients in positions that help drain mucus, and then vibrate the patients’ rib cages and instruct the patients to cough.

Respiratory therapists also administer aerosols—liquid medications suspended in a gas that forms a mist, which is inhaled—and teach patients how to inhale the aerosol properly to ensure its effectiveness.

In some hospitals, therapists perform tasks that fall outside their traditional role. Therapists’ tasks are expanding into 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. 

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.

Working Conditions:
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 a great deal of stress. Respiratory therapists employed in home health care must travel frequently to the homes of patients.

Respiratory therapists are trained to work with hazardous 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 run the risk of catching an infectious disease, but carefully following proper procedures minimizes this risk.