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Chapter 1 History of Respiratory Care

Chapter 1 History of Respiratory Care. Learning Objectives. Define “respiratory care.” Summarize some of the major events in the history of science & medicine. Explain how the respiratory care profession got started.

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Chapter 1 History of Respiratory Care

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  1. Chapter 1History of Respiratory Care

  2. Learning Objectives Define “respiratory care.” Summarize some of the major events in the history of science & medicine. Explain how the respiratory care profession got started. Describe the historical development of the major clinical areas of respiratory care. Name some of the important historical figures in respiratory care. Describe the major respiratory care educational, credentialing, & professional associations.

  3. Learning Objectives • Explain how the important respiratory care organizations got started. • Describe the development of respiratory care education. • Predict future trends for respiratory care.

  4. History of Respiratory Medicine & Science • Ancient Times • Early cultures developed herbal remedies for many diseases • Foundation of modern medicine: attributed to “father of medicine,” Hippocrates, Greek physician living during 5th & 4th centuries BC

  5. History of Respiratory Medicine & Science (cont.) • Ancient Times (cont.) • Hippocratic medicine:based on four essential fluids: phlegm, blood, yellow bile, & black bile • Hippocrates believed air contained essential substance distributed to body via heart • The Hippocratic oath: calls for physicians to follow certain ethical principles • Given to most medical students at graduation

  6. History of Respiratory Medicine & Science (cont.) • Ancient Times (cont.) • Other great scientists of this time period • Aristotle (342322 BC)first great biologist • Erasistratus (330240 BC)developed pneumatic theory of respiration in Egypt • Galen (130199 AD)anatomist who believed air had substance vital to life

  7. History of Respiratory Medicine & Science (cont.) • Middle Ages • Fall of Roman empire (476 AD): resulted in period of slow scientific progress • Intellectual rebirth in Europe began in 12th century • Leonardo da Vinci (14531519) determined subatmospheric pressures inflated lungs • Andreas Vesalius (15141564) performed human dissections & experimented with resuscitation

  8. History of Respiratory Medicine & Science (cont.) • Enlightenment Period • 1754: Joseph Black described properties of CO2 • 1774: Joseph Priestley describes his discovery of oxygen - “dephlogisticated air” • Lazzaro Spallazani describes tissue respiration • 1787: Jacques Charles describes relationship between gas temperature & volume - “Charles law” • 1778: Thomas Beddoes uses oxygen to treat various conditions at Pneumatic Institute

  9. History of Respiratory Medicine & Science (cont.) • 19th & Early 20th Century • 1801: John Dalton describes his law of partial pressures • 1808: Joseph Louis Gay-Lussac describes relationship between gas temperature & pressure • 1831: Thomas Graham describes law of diffusion for gases (Graham’s law)

  10. History of Respiratory Medicine & Science (cont.) • 19th & Early 20th Century (cont.) • 1865: Louis Pasteur advanced his “germ theory” & suggestes that some diseases were result of microorganisms • 1846: spirometer & ether anesthesia invented • 1896: William Roentgen discoveres x-ray - opens door for modern field of radiology

  11. Which scientist described his law of diffusion for gases in the 19th century? A. John Dalton B. Thomas Graham C. Jacques Charles D. Joseph Louis Gay-Lussac

  12. Development of the Respiratory Care Profession • 1940s: technicians hauled O2 cylinders & apply O2 delivery devices • 1950s: positive-pressure breathing devices applied to patients • 1960s: Formal education programs for inhalation therapists • Development of sophisticated mechanical ventilators in the 1960s expanded role of respiratory therapist (RT)

  13. Development of the Respiratory Care Profession (cont.) RTs responsible for arterial blood gas & pulmonary function laboratories 1974: designation “respiratory therapist” becomes standard Practice of Respiratory Therapy, originally U.S. & Canada now expands globally 1980: Respiratory Care Week established nationally to promote profession & importance of good lung health

  14. How long after initially applying positive pressure breathing devices to patients did the first sophisticated mechanical ventilator become available, expanding the role of Respiratory Therapists? A. 10 years B. 20 years C. 30 years D. 40 years

  15. Development of the Respiratory Care Profession (cont.) • Oxygen Therapy • 1907: Large-scale production of O2 developed by Karl von Linde. • 1910: Oxygen tents first used • 1918: O2 masks first used • 1940s: O2 therapy widely prescribed

  16. Development of the Respiratory Care Profession (cont.) 1960s: Clark electrode first developed - allows measurement of arterial PO2 1974: Ear oximeter invented 1980s: Pulse oximeter invented 1960: Venti mask to deliver specific FIO2 introduced 1970s: Portable liquid O2 systems for long-term oxygen therapy (LTOT) in home introduced

  17. Development of the Respiratory Care Profession (cont.) • 21st century marks further advances in home oxygen therapy equipment • New equipment introduced for Long Term Oxygen Therapy include: • Oxygen concentrators with pressure booster (allows transfilling in home) • Smaller, lightweight portable oxygen concentrators

  18. Development of the Respiratory Care Profession (cont.) • Aerosol Medications • 1910: aerosolized epinephrine introduced as treatment for asthma • 1940s-1950s: Isoproterenol (1940) & isoetharine (1951) introduced as bronchodilators • 1971s: Aerosolized steroids first used to treat acute asthma

  19. Development of the Respiratory Care Profession (cont.) • Aerosol Medications • 1980: Advances in bronchodilator therapy - Albuterol sulfate introduced & still used today • 2000: Levalbuteral introduced • Newer aerosol medication delivery devices include dry powder inhaler (DPI) • Innovative designs for small volume nebulizers (SVN’s) invented

  20. Development of the Respiratory Care Profession (cont.) • Mechanical Ventilation • 1928: Iron lung introduced by Philip Drinker • 1940s-1950s: Jack Emerson develops improved version of iron lung used for polio victims • 1950s: Negative-pressure “wrap” ventilator introduced

  21. Development of the Respiratory Care Profession

  22. Mechanical Ventilation Originally, positive-pressure ventilation used during anesthesia The Drager Pulmotor (1911), Spiropulsator (1934), the Bennett TV-2P (1948) & Bird Mark 7 (1958) were positive-pressure ventilators Bennett MA-1, Ohio 560, & Engstrom 300 were introduced in 1960s as volume-cycled ventilators.

  23. Development of the Respiratory Care Profession

  24. Development of the Respiratory Care Profession

  25. Mechanical Ventilation (cont.) More advanced volume ventilators became available in 1970s: Servo 900, Bourns Bear I & II, & MA II First microprocessor-controlled ventilators developed in 1980s (Bennett 7200) Ventilators with capability of applying advanced modes of ventilation became available in 21st century Due to use of endotracheal tube, mechanical ventilation increases risk for ventilator-associated pneumonia (VAP) Non-invasive ventilation, when applicable, can prevent this risk.

  26. All of the following are true about ventilator associated pneumonia (VAP), except: A. it can occur in both mechanically ventilated & spontaneously breathing patients B. death is a potential risk of VAP C. non-invasive ventilation may be used to avoid VAP D. there are very costly consequences when a patient acquires VAP

  27. Airway Management 1980: William MacEwen successfully applied first endotracheal tube to patient 1913: laryngoscope introduced 1941: First suction catheter described 1970s: Low-pressure cuffs for endotracheal tubes introduced

  28. Cardiopulmonary Diagnostics 1800: Measurement of lung’s residual volume first performed 1846: first water-sealed spirometer developed by John Hutchinson 1967: rapid arterial blood gas analysis becomes available 1980s: Polysomnography becomes routine

  29. Professional Organizations Inhalation Therapy Association (ITA) founded in 1947 ITA became American Association for Inhalation Therapists (AAIT) founded in 1954 AAIT became American Association for Respiratory Therapy (AART) founded 1973 AART became American Association for Respiratory Care (AARC) founded in 1982

  30. Professional Organizations (cont.) 1980s: state licensure for RTs begins State licensure based on RTs passing entry level exam offered by National Board for Respiratory Care (NBRC) NBRC offers certification & registry examination for RTs State licensing laws set minimum educational requirements & determine competence to practice State licensing boards also set required amount of continuing education credits (CEU’s) required to keep license to practice

  31. Professional Organizations (cont.) AARC advocates for profession to legislative & regulatory bodies, insurance industry & public AARC sponsors continuing professional educational activities, including conferences to gain CEU’s - go to www.AARC.org AARC publishes monthly science journal RESPIRATORY CARE & news magazine: AARC Times AARC members may join any of 10 Specialty Sections 2002: AARC, NBRC, & CoARC formally express support for all RT’s to seek & obtain RRT credential

  32. In what year did it become a requirement for Respiratory Therapists to be licensed by the state in which they practice? A. 2000 B. 1990 C. 1980 D. 1970

  33. Respiratory Care Education 1950: First formal RT program was offered in Chicago 1960s: Programs multiply - many hospital based Currently: Associates (AS) Degree in Respiratory Care (RC) is minimum educational requirement AS Degree’s represent majority of all educational programs More than 350 RT education programs exist in U.S. 2003: AARC formally encourages development of baccalaureate & graduate education in RC

  34. Which of the following sets the minimum educational requirements & the method of determining competence to practice Respiratory Care? A. AARC B. BOMA C. State licensing laws D. NBRC

  35. Respiratory Care Education • Due to aging population(baby boomers): • Increased demand for RC services & RT’s • As baby boomers age: • More will have asthma, COPD, & other cardiopulmonary diseases • As treatments & technology continue to advance: • RT’s will require more educational preparation

  36. Respiratory Care Education • RT’s of future will focus more on: • Prevention • Protocol administration • Care plan development • Disease management & rehabilitation • Family & patient education • Tobacco cessation counseling

  37. Future of Respiratory Care • “2015 & Beyond”—Special task force created by AARC • Formed in 2007 as AARC recognized impending overhaul of U.S. healthcare system • Task—to envision potential roles & responsibilities of RT by 2015 & beyond • 3 strategic conferences held: 2008, 2009, 2010

  38. Future of Respiratory Care (cont.) • Aim: to answer 5 questions about future of profession: • How patients will receive health care services • How respiratory care services will be provided • Knowledge, skills, attributes needed by RT’s • Educational & credentialing systems necessary • How to transition with little impact on practicing RT’s

  39. Future of Respiratory Care (cont.) • Task force concludes: RT’s need to be competent in 7 major areas by 2015: • Diagnostics • Chronic disease state management • Evidence-based medicine & Respiratory Care protocols • Patient Assessment • Leadership • Emergency & Critical Care • Therapeutics

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