Chapter 1 History of Respiratory Care

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Chapter 1

History of Respiratory Care

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 2

Learning Objectives

1. Define “respiratory care.”

2. Summarize some of the major events in the history of science & medicine.

3. Explain how the respiratory care profession got started.

4. Describe the historical development of the major clinical areas of respiratory care.

5. Name some of the important historical figures in respiratory care.

6. Describe the major respiratory care educational, credentialing, & professional associations.


Learning Objectives

7. Explain how the important respiratory care organizations got started.

8. Describe the development of respiratory care education.

9. Predict future trends for respiratory care.


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


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

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.


Ancient Times (cont.) Other great scientists of this time period

• Aristotle (342322 BC)first great biologist

• Erasistratus (330240 BC)developed pneumatic theory of respiration in Egypt

• Galen (130199 AD)anatomist who believed air had substance vital to life

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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 (14531519) determined

subatmospheric pressures inflated lungs Andreas Vesalius (15141564) performed human

dissections & experimented with resuscitation



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



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)



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


Which scientist described his law of diffusion for gases in the 19th century?

A. John Dalton B. Thomas Graham C. Jacques CharlesD. Joseph Louis Gay-Lussac


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)


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


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 yearsB. 20 yearsC. 30 yearsD. 40 years



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



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



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



Aerosol Medications1910: aerosolized epinephrine introduced as

treatment for asthma1940s-1950s: Isoproterenol (1940) & isoetharine

(1951) introduced as bronchodilators1971s: Aerosolized steroids first used to treat

acute asthma



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



Mechanical Ventilation1928: Iron lung introduced by Philip Drinker1940s-1950s: Jack Emerson develops improved

version of iron lung used for polio victims1950s: Negative-pressure “wrap” ventilator

introduced




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.






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.


All of the following are true about ventilator associated pneumonia (VAP), except:

A. it can occur in both mechanically ventilated & spontaneously breathing patientsB. death is a potential risk of VAPC. non-invasive ventilation may be used to avoid VAPD. there are very costly consequences when a patient acquires VAP


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


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


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


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


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


In what year did it become a requirement for Respiratory Therapists to be licensed by the state in which they practice?

A. 2000B. 1990C. 1980D. 1970


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


Which of the following sets the minimum educational requirements & the method of determining competence to practice Respiratory Care?

A. AARCB. BOMAC. State licensing lawsD. NBRC



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



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


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


Future of Respiratory Care (cont.)

Aim: to answer 5 questions about future of profession:1. How patients will receive health care services

2. How respiratory care services will be provided

3. Knowledge, skills, attributes needed by RT’s

4. Educational & credentialing systems necessary

5. How to transition with little impact on practicing RT’s


Future of Respiratory Care (cont.)

Task force concludes: RT’s need to be competent in 7 major areas by 2015:1. Diagnostics

2. Chronic disease state management

3. Evidence-based medicine & Respiratory Care protocols

4. Patient Assessment

5. Leadership

6. Emergency & Critical Care

7. Therapeutics

Documents

Chapter 1 History of Respiratory Care