Respiratory Therapist

1. 1
   Complete a CAAHEP-Accredited Respiratory Therapy Program

   Respiratory therapy programs are AAS degrees (2 years) accredited by CAAHEP. Curriculum: respiratory anatomy and physiology, respiratory pathophysiology, oxygen therapy, bronchopulmonary hygiene, airway management, mechanical ventilation, pulmonary function testing, neonatal/pediatric care, and clinical rotations across medical/surgical, ICU, ED, and neonatal units. CoARC (Commission on Accreditation for Respiratory Care) programs are what to look for.

   CoARC-accredited RT AAS program
2. 2
   Pass the CRT and RRT Exams

   The NBRC (National Board for Respiratory Care) offers two credentials: CRT (Certified Respiratory Therapist — the entry credential, taken after completing the program) and RRT (Registered Respiratory Therapist — the advanced clinical credential). The RRT requires passing the CRT plus the Therapist Multiple Choice (TMC) exam at the "high cut" score AND the Clinical Simulation Exam (CSE). Most positions beyond entry-level require RRT. The RRT demonstrates clinical decision-making ability, not just knowledge.

   CRT then RRT — NBRC
3. 3
   Develop Mechanical Ventilation Expertise

   Mechanical ventilation management — setting ventilator modes, weaning parameters, interpreting arterial blood gases, and managing ventilator complications — is the most critical skill in critical care respiratory therapy. ICU RTs who can independently manage complex ventilated patients and provide expert support to intensivists are among the most clinically autonomous non-physician healthcare professionals. This expertise takes 2–3 years of dedicated ICU experience.

   Mechanical ventilation mastery
4. 4
   Earn ACCS or NPS Specialty Credential

   NBRC specialty credentials significantly increase income: ACCS (Adult Critical Care Specialist) — the advanced credential for ICU respiratory therapists. NPS (Neonatal/Pediatric Specialist) — for RTs specializing in neonatal ICU and pediatric respiratory care, where premature infants on small ventilators require specialized expertise. Both require additional clinical experience and passing specialty examinations.

   ACCS or NPS specialty credential
5. 5
   Pursue ICU Team Lead or Pulmonologist Practice Collaboration

   Lead respiratory therapists in ICUs ($80K–$90K) manage the RT team and serve as clinical resources for complex ventilator management. Some RTs develop collaborative practice relationships with pulmonologists — managing ventilator changes and weaning protocols with significant clinical autonomy. Hospital Director of Respiratory Services ($90K–$95K+) is the management advancement path.

   ICU lead or management advancement

• 6:45 AMShift report — the outgoing RT briefs on all mechanically ventilated patients in the 22-bed MICU. 8 patients currently on ventilators: 2 ARDS patients on ARDSnet protocol, 1 patient being weaned (spontaneous breathing trial this morning), 3 post-operative patients being mobilized for extubation, 2 new admissions overnight.
• 7:00 AMPatient rounds — attend the morning interdisciplinary ICU rounds with physicians, nurses, pharmacists, and case managers. Present the respiratory status and ventilator parameters for each ventilated patient. Recommend an increase in PEEP for one ARDS patient based on overnight oxygenation trend.
• 8:00 AMSpontaneous breathing trial — conduct an SBT on a patient being weaned from ventilation. Switch to a pressure support mode, reduce settings, monitor for 30 minutes: respiratory rate, tidal volume, SpO2, patient comfort and effort. Patient passes — recommend extubation to the attending physician.
• 8:45 AMExtubation — with physician at the bedside, remove the endotracheal tube in a controlled fashion. Position the patient, suction, deflate cuff, withdraw the tube. Apply high-flow oxygen. Patient breathing comfortably and speaking. Success.
• 10:00 AMNew admission — acute respiratory failure. Help intubate with the attending. Set initial ventilator settings based on patient weight and diagnosis. Draw an arterial blood gas 30 minutes post-intubation. ABG results: pH 7.28, PaCO2 55, PaO2 82. Adjust the rate to improve CO2 elimination.
• 12:00 PMLunch — 30 minutes.
• 12:30 PMBronchoscopy assist — assist the pulmonologist with a therapeutic bronchoscopy for mucus plugging. Connect the bronchoscope to oxygen, monitor SpO2 throughout the procedure, suction secretions through the scope.
• 3:00 PMBreathing treatments — respiratory treatments (inhaled bronchodilators via nebulizer or MDI) for non-ventilated patients: COPD exacerbation patients, post-surgical patients, pneumonia patients with significant secretions.
• 5:00 PMEnd of shift — review all ventilated patients' afternoon blood gases and ventilator changes. Brief the incoming RT thoroughly on each patient's status, trajectory, and any anticipated changes.

Respiratory therapists manage the most critical life-sustaining interventions in the hospital — mechanical ventilation, airway management, and cardiopulmonary resuscitation. AI is entering through ventilator management systems and early warning tools, but the clinical judgment, manual skill, and patient communication of RT practice are not automatable.