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Chapter 15 |
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"Because the cardio and pulmonary systems are so interdependent, it is very important to know the global physiology of the body."
Stephen Lowenstein is a respiratory therapist and technical director of the Pulmonary Physiology Laboratory at Lenox Hill Hospital in New York City. Respiratory therapy is a part of the diagnosis, surgical treatment, and postoperative care of patients. Although a typical day for a respiratory therapist can include a lot of variety, one constant for Stephen is that he is always treating or evaluating patients sent to him by their doctors. "Physicians request preoperative testing for patients who are headed for surgery as well as diagnostic tests for patients with shortness of breath, asthma, and occupation-related diseases," says Stephen. "We also manage mechanical ventilation for patients on respirators, draw blood gases, perform pulmonary tests, and distribute medications to postoperative patients." There are many types of tests in respiratory therapy, including cardiopulmonary stress tests (during which the patient exercises on a stationary bicycle), gas analysis, and lung volume tests. In addition, respiratory therapists are an integral part of the cardiopulmonary surgery team. "In surgery, we do endotrachial intubations, we open the airways of emergency patients, and we do life support, putting patients who have had open heart procedures on a mechanical ventilator." In all of these roles, a thorough understanding of anatomy and physiology is crucial. Stephen says, "In respiratory therapy, it's important to know the physiology of how the body works. When you give medications to a patient, you have to monitor how the person reacts to them. When you do physiological stress testing, you have to know how blood pressure, heart rate, and the lungs react to different levels of exercise. When we put patients on a mechanical ventilator, we are pushing in a certain volume of air at a certain frequency and oxygen concentration. Changing the pressure will change cardiac output and venous return, as well as other aspects. Because these systems are so interdependent, it is very important to know the global physiology of the body." A two-year degree and completion of an oral and written certification exam are required in this field. A certified respiratory therapist (CRT) is qualified to administer diagnostic tests, maintain and monitor mechanical ventilation, draw blood gases, intubate patients, and do chest therapy. CRTs can work in hospitals, pulmonary rehabilitation, or home care therapy. In this allied health field, there are additional opportunities for therapists who continue their education at the four-year undergraduate, master's, and doctorate levels and for those who acquire the status of a state-registered or nationally registered respiratory therapist. According to Stephen, respiratory therapists perform a vital role in "evaluating a patient's pulmonary status and making recommendations to the physician." Stephen points out that it can be challenging to do the job well. "It seems like more of an art than a science sometimes. Doing a complete and accurate test on a patient, who may not be able to fully participate, can be difficult. Results may vary depending on how and when you perform the test. You want the test results to reflect the true situation." However, he says, "giving an accurate understanding of the problem to the physician is very rewarding." Stephen advises those interested in respiratory therapy to visit a local two- or four-year training program and to arrange to observe therapists at work at a hospital. He also recommends visiting the websites of national organizations. The National Board for Respiratory Care (www.nbrc.org) certifies respiratory therapists and sets standards for care. The American Respiratory Care Foundation (www.arcfoundation.org) supports research and education. It offers awards at both student and professional levels.
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