Respiratory care clinics of North America
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Respir Care Clin N Am · Sep 2005
ReviewEducation and credentialing in respiratory care: where are we and where should we be headed?
Respiratory care is indeed at a crossroads. The profession will continue to develop by advancing the education and credentialing needed to function as physician extenders-true cardiopulmonary physician's assistants. As such, the respiratory therapist of the future will focus on patient assessment,care plan development, protocol administration, disease management and rehabilitation, and patient and family education, including tobacco education and smoking cessation. ⋯ Professional associations and accrediting agencies should promote the development of additional baccalaureate and master's degree programs in respiratory care. Education is best defined as positive behavior change. Amplified education can only improve the ability of respiratory therapists to contribute to the cardiopulmonary health of people worldwide.
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Respir Care Clin N Am · Sep 2005
Training and education challenges for the twenty-first century: respiratory care competency and practice.
In recent years, there has been a paradigm shift in the roles and responsibilities of respiratory therapists. Therapists increasingly are expected to design and implement respiratory care plans within the scope of protocols. ⋯ The greatest impact on respiratory care practice is likely to be the increasing use of the principles of evidence-based medicine. Each of these factors will affect how respiratory therapists should be trained and educated in the twenty-first century.
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Respir Care Clin N Am · Sep 2005
New roles for respiratory therapists: expanding the scope of practice.
With diverse training and experience, respiratory therapists enjoy a wide variety of employment opportunities. The profession is moving beyond the traditional acute-care facility, such as a hospital, into extended care, sleep medicine, disease management, patient transport, and even fields beyond health care delivery, such as education and research. Respiratory therapists will survive in these changing times if they possess the ability to recognize change as an opportunity for growth. As the baby boomer generation ages, and the incidence of chronic illness increases, respiratory therapists will be in even greater demand.
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During conventional mechanical ventilation, fixed set pressure, flow, and tidal volume result in a mismatch between patient and ventilator inspiratory time and in a patient's inability to adapt to changing ventilatory demand. Synchrony between the patient and ventilator improves neuromuscular coupling and the ability to adapt to increased ventilatory demand or loading. The sensation of dyspnea prevents ineffective inspiratory efforts and attenuates periodic breathing during sleep.
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During assisted mechanical ventilation, the total pressure applied to respiratory system is the sum of ventilator and muscle pressure. As a result, the respiratory system is under the influence of two pumps, the ventilator pump (ie, Paw), which is controlled by the physician's brain and the capabilities of the ventilator, and the patient's own respiratory muscle pump (Pmus), which is controlled by the patient's brain. ⋯ The achievement of this harmony depends exclusively on the physician, who should be aware that during assisted mechanical ventilation the respiratory system is not a passive structure but reacts to pressure delivered by the ventilator via various feedback systems and, depending on several factors both to the ventilator and patient, may modify the function of the ventilator. Finally, the physician should know that the ventilator imposes significant constraints to the respiratory system, the magnitude of which depends heavily on the triggering variable, the variable that controls the gas delivery and the cycling off criterion.