Chapter 1_Early History of Respiratory Care (1).pptx

Early History of Respiratory Care Chapter #1 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 began. 4. Describe the historical development of the major clinical areas of respiratory...

Early History of Respiratory Care Chapter #1 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 began. 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. 2 7. Explain how the important respiratory care organizations got started. 8. Describe the development of respiratory care education. 3 Definitions ▪ Respiratory care, also known as respiratory therapy, has been defined as the health care discipline that specializes in the promotion of optimal cardiopulmonary function and health. ▪ Respiratory therapists (RTs) apply scientific principles to prevent, identify, and treat acute or chronic dysfunction of the 4 Definitions ▪Respiratory care includes 1. Assessment 2. Treatment 3. Management 4. Control 5. Diagnostic evaluation 6. Education 7. Care of patients with deficiencies and abnormalities of the cardiopulmonary system. 5 Definitions ▪ Respiratory care is increasingly involved in the prevention of respiratory disease, the management of patients with chronic respiratory disease, and the promotion of health and wellness. ▪ RTs, respiratory care practitioners, are health care professionals who are educated and trained to provide respiratory care to patients. 6 ▪ RTs work in hospitals or other acute care settings. ▪ Many RTs are employed in clinics, physicians’ offices, skilled nursing facilities, and cardiopulmonary diagnostic laboratories. ▪ Others work in research, disease management programs, home care, and industry. ▪ RTs are also employed by colleges and universities to teach students the skills they need to become RTs. 7 History of Respiratory Medicine & Science ▪Ancient Times ▪Early cultures developed herbal treatments for many diseases. ▪Foundation of modern western medicine: attributed to “father of medicine,” Hippocrates, Greek physician living during 5th & 4th centuries BC. 8 History of Respiratory Medicine & Science ⚫Ancient Times (cont.) (cont.) ▪Hippocratic medicine was based on four essential fluids (phlegm, blood, yellow bile, & black bile) and the four elements—earth (cold, dry), fire (hot, dry), water (cold, moist), and air (hot, moist). ▪ Diseases were thought to be humoral disorders caused by imbalances in these essential substances. ▪Hippocrates believed air contained essential substance distributed to body via heart. 8 History of Respiratory Medicine & Science ⚫Ancient Times (cont.) ▪Other great scientists (cont.) of this time period Aristotle (342−322 BC First great biologist ) Erasistratus (330−240 Founder of the science of physiology BC) developed pneumatic theory of respi ration in Egypt in which air (pneuma) entered the lungs and was transferred to the heart. Galen (130−199 AD) anatomist who believed the air has a substance that is a vital to life 10 History of Respiratory Medicine & Science ⚫Middle Ages (cont.) ▪Fall of Roman empire (476 AD): resulted in period of slow scientific progress ▪ In the seventh century ad, A golden age of Arabian medicine (850 to 1050 ad). ▪Intellectual rebirth in Europe began in 12th century ▪Leonardo da Vinci (1453−1519): • determined subatmospheric pressures inflated lungs. intrapleural • observed that fire consumed a vital substance in air without 11 History of Respiratory Medicine & Science ▪ Vesalius (1514 to 1564) • considered to be the founder of the modern field of human (cont.) anatomy. • performed human dissections & experimented with resuscitation ▪ In 1628, Harvey described the circulatory system ▪ In 1662, the chemist Boyle published “Boyle’s law”(governing the relationship between the volume and pressure of a gas). ▪ Torricelli invented the barometer in 1650, ▪ Pascal showed that atmospheric pressure decreases with altitude. 12 History of Respiratory Medicine & Science ⚫Enlightenment Period (cont.) ▪1754: Joseph Black described properties of CO 2 ▪1774: Joseph Priestley describes his discovery of oxygen. ▪1787: Jacques Charles describes relationship between gas temperature & volume - “Charles law” ▪ between 1775 and 1794: Lavoisier showed that oxygen was absorbed by the lungs and that carbon dioxide and water were exhaled ▪1798: Thomas Beddoes uses oxygen to treat 13 History of Respiratory Medicine & Science ⚫19th & Early 20th Century ▪1801: John Dalton (cont.) describes his law of partial pressures for a gas mixture ▪ 1805- 1806: Young and de LaPlace described the relationship between pressure and surface tension in fluid droplets. ▪1808: Joseph Louis Gay-Lussac describes relationship between gas temperature & pressure ▪1831: Thomas Graham describes law of diffusion for gases (Graham’s law) 14 History of Respiratory Medicine & Science ⚫19th & Early 20th Century (cont.) (cont.) ▪1846: invention of the spirometer & measures the vital capacity. ▪1865: Louis Pasteur advanced his “germ theory” & suggests that some diseases were caused by microorganisms. ▪1895: William Roentgen discovers x- ray - opens door for modern field of radiology. 15 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 16 (B) 1831: Thomas Graham describes law of diffusion for gases (Graham’s law) 17 Development of the Respiratory Care Since the era when the scientific basis for oxygen Profession therapy, mechanical ventilatory support, and administration of medical aerosols became well established, the need for a health care practitioner to provide these services became apparent. 18 Development of the Respiratory Care Profession ▪ 1940s: The first health care specialists in the field were oxygen technicians ▪ 1950s: positive-pressure breathing devices developed during World War II for breathing support, and those devices were applied to treat pulmonary patients and deliver aerosol medications. ▪ 1960s: Formal education programs for inhalation therapists ▪ provided oxygen therapy via H cylinders and oxygen tents, masks, and nasal catheters ▪ delivered aerosolized medications and performed intermittent positivepressure breathing (IPPB) treatments ▪ Development of sophisticated mechanical ventilators in the 1960s expanded role of 19 Development of the Respiratory Care Profession (cont.) ▪ 1974: designation “respiratory therapist” becomes standard • RT became the allied health professional primarily concerned with the assessment, diagnostic testing, treatment, education, and care of patients with deficiencies and abnormalities of the cardiopulmonary system. ▪ Practice of Respiratory Therapy, originally U.S. & Canada now expands globally 20 Development of the Respiratory Care Profession ⮚ Oxygen Therapy ⮚ 1878: Bert showed that lack of oxygen caused hyperventilation ⮚ Physiologic basis and indications for oxygen therapy were not well understood until the 20th century. ⮚ 1907: Large-scale production of O2 developed by Karl von Linde. Also, The use of a nasal catheter for oxygen administration was introduced by 21 Development of the Respiratory Care Profession (cont.) ⮚ 1918: O2 masks first used ⮚ 1920: oxygen tent to treat leg ulcers ⮚ 1940s: O2 therapy widely prescribed 22 Development of the Respiratory Care Profession (cont.) The BLB mask (Boothby, Lovelace, and Bulbulian) to administer 80% to 100% oxygen to pilots was introduced during World War II and later used on patients in the 1950s and 1960s. 23 Development of the Respiratory Care Profession ▪ 1960s: Clark electrode first developed (cont.) - allows measurement of arterial PO2 ▪ 1974: Clinical use of ear oximeter ▪ 1980s: Clinical use of pulse oximeter ▪ 1960: • Venti mask to deliver specific FIO2 was introduced (24%, 28%, 35%, or 40% oxygen) • Modern versions of the nasal cannula, simple oxygen mask, partial rebreathing mask, and nonrebreathing mask were available. ▪ 1970s: Portable liquid O2 systems for long-term oxygen therapy (LTOT) in home were introduced ▪ 1980s: Oxygen-conserving devices (reservoir cannulas, demand pulse oxygen systems, and 24 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 of small portable oxygen cylinders in the home) ▪Smaller, lightweight portable oxygen concentrators 25 Development of the Respiratory Care Profession ⚫Aerosol Medications: ⚫Administration of liquid or powdered aerosol particles via inhalation to achieve a desired therapeutic effect. ▪1910: first use of aerosolized epinephrine introduced as aerosol medication ▪Other short acting bronchodilators for asthma attacks: Isoproterenol (1940), isoetharine (1951), metaproterenol (1961), Albuterol Sulfate (1980), and Levalbuterol (2000). ▪1970s: Aerosolized steroids first used to treat asthma 26 Development of the Respiratory Care Profession ▪ Aerosol Medications ▪In late 1990s: Long Acting BDs were interduced as treatment for COPD ▪2000: Levalbuteral introduced ▪Newer aerosol medication delivery devices include dry powder inhaler (DPI) ▪Innovative designs for small volume nebulizers (SVN’s) invented 27 Development of the Respiratory Care Profession ⚫Mechanical Ventilation ▪Involves the use of mechanical device to provide ventilator support for patients. ▪1832: first negativepressure tank ventilator was described. Negative-pressure ventilator used in the 28 Development of the Respiratory Care Profession (cont.) ▪1928: Iron lung developed by Philip Drinker ▪Iron lung was used extensively during polio epidemics (1940s-1950s) 29 Development of the Respiratory Care Profession Iron lung patients in a 1950s polio 30 Development of the Respiratory Care Profession Modern negative-pressure ventilator used in Europe. 31 Development of the Respiratory Care Profession (cont.) ▪1900s: Chest Cuirass negative pressure ventilator was introduced. ▪1950s: Negative-pressure “wrap” ventilator introduced 32 ● Originally, positive-pressure ventilation was used during anesthesia. ● Early PP Ventilators: 1. 2. 3. 4. 5. The Drager Pulmotor (1911) Spiropulsator (1934) Bennett TV-2P (1948) Morch Piston Ventilator (1952) Bird Mark 7 (1958) 33 • Top left, Morch ventilator • Bottom left, Engstrom 300 ventilator 34 • • • • Top left, Bird Mark 7 ventilator Top right, Puritan-Bennett TV-2P ventilator Bottom left, Bird Mark 8 ventilator Bottom right, Puritan- Bennett PR-2 ventilator 35 ▪ 1960s: Positive Pressure Volume Ventilators were developed: 1. 2. 3. 4. Emerson Postoperative Ventilator Bennett MA-1 Ohio 560 Engstrom 300 36 ▪ 1970s: More advanced volume ventilators became available: 1. 2. 3. Servo 900 Bourns Bear I and II MA II. ▪ 1980s: The first microprocessorcontrolled ventilators were developed (Bennett 7200). 37 ▪ Ventilators with the capability of applying advanced modes of ventilation became available in the 21st century. • Left, Covidien 840 ventilator • Middle, Viaysis Avea ventilator • Right, Siemens Servo i 3 9 use of various techniques and devices to establish or maintain a functional airway ▪ 1880: William MacEwen successfully applied first endotracheal tube to patient ▪ 1913: laryngoscope introduced ▪ 1930: Magil nasal intubation ▪ 1941: First suction catheter described by Murphy ▪ 1970s: Low-pressure cuffs for endotracheal tubes 39 ▪ comprises a wide range of diagnostic procedures to measure and evaluate lung function ▪ 1679: First measure of the volume of air that can be inhaled in a single deep breath ▪ 1800: Measurement of lung’s residual volume first performed ▪ 1846: first water-sealed spirometer developed by John Hutchinson • Measured Vital Capacity • observed the relationship between height and lung volume and that 40 ▪ 1868: Hering and Breuer described the effects of lung inflation and deflation on breathing—the Hering-Breuer reflex. ▪ 1919 and 1948: use of the force vital capacity and forced expiratory volume in 1 second were suggested to be used for obstructive lung disease ▪ 1920: methods to measure blood oxygen and carbon dioxide levels became available. ▪ 1967: rapid arterial blood gas analyzer becomes available for the medical use ▪ 1980s: Sleep medicine (Polysomnography) becomes well established 41 American Association for Respiratory Care ▪ Inhalation Therapy Association (ITA) founded in Chicago, 1947. • first professional association for the field of respiratory care • The purpose was to provide for professional advancement, foster cooperation with physicians, and advance the knowledge of inhalation therapy through educational activities. ▪ 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 42 Professional ▪ The stated mission of the AARC is to “encourage and Organizations promote professional excellence, advance the science and practice of respiratory care, and serve as an advocate for patients, their families, the public, the profession, and the respiratory therapist.” 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 43 44 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 45 ▪ AARC: national professional organization, sets national standards for the profession, primary advocacy group ▪ NBRC: Credentialing body, must pass this national test to become licensed. They are responsible for all credentialing (CRT, RRT, NPS…) founded in 1974 ▪ COARC: agency responsible for maintaining RT educational programs 46 In what year did it become a requirement for Respiratory Therapists to be licensed by the state in which they practice? A. 2000s B. 1990s C. 1980s D. 1970s 47 Respiratory Care ▪ 1982:Week Respiratory Care Week established nationally to promote pulmonary health and the work of RTs in all care settings ▪ Respiratory care week is the third week of each October ▪ A yearly event to promote lung awareness and the work of respiratory therapists in all care settings. ▪ Helps raise awareness of the vital role the respiratory therapist plays as a member of the health care team. ▪ An excellent opportunity for respiratory therapy students to become ambassadors of the profession to the rest of the student body. ▪ Som4e respiratory therapy classes conduct free breathing tests ▪ Board of Medical Advisors (BOMA): • is the group of physicians who provide this valuable and formal input on all matters and questions pertaining to patient care to the AARC leadership. ▪ American Respiratory Care Foundation (ARCF): • is a not-for-profit charitable foundation that helps promote and further the mission of the AARC. • collects and manages contributions from individuals, corporations, and other foundations to promote education among RTs and to recognize individual achievements of excellence in clinical practice, chronic disease management, public respiratory health, scientific research, and scholarship 49 ▪ International Council for Respiratory Care (ICRC): • is an AARC-sponsored organization dedicated to the globalization of high-quality respiratory care. • offer fellowships to interested foreign clinicians that provide the opportunity to visit the United States for 2 weeks before the annual International Respiratory Congress to observe how respiratory care is practiced in various settings. ▪ National Board for Respiratory Care (NBRC): • 1968: merge the two groups (American Registry of Inhalation Therapists and certification board) to establish the National Board for Respiratory Therapy. • 1983: the National Board for Respiratory Therapy became as National Board for Respiratory Care. • 1998: renamed the lower level certified respiratory therapist (CRT); the advanced level registered respiratory therapist 50 ▪ Committee on Accreditation for Respiratory Care (CoARC): ▪ Respiratory care educational programs in the United States and Canada are accredited by CoARC in collaboration with the Association of Specialized and Professional Accreditors. 51 ▪ 1950: First formal inhalation therapy 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. ▪ At present there are approximately 300 associate, 50 baccalaureate, and 3 graduate-level degree programs in the United States; 19 programs in Canada; ▪ 2003: AARC formally encourages development of baccalaureate & graduate education in RC ▪ Jobs in management, education, research, or advanced clinical practice normally require bachelor’s- or graduate-level educational preparation. 52 Future of Respiratory Care ▪ Trends affecting the field: ▪ Due to aging population: ▪Increased demand for RC services & RT’s ▪ advances in technology 53 Future of Respiratory Care (cont.) ▪ RT’s of future will focus more on: ▪ Prevention ▪ protocol-based care ▪ Care plan development ▪ Disease management & rehabilitation ▪ Family & patient education ▪ Tobacco education and smoking cessation. ▪ outcome evaluation 54 Summary: • The American Registry of Inhalation Therapists was founded in 1960. • The NBRC, the credentialing board for RTs, was founded in 1974. • The first Board of Schools was established in 1963. • As the physiologic basis for oxygen therapy became understood, use of oxygen to treat respiratory disease became established by the 1920s, and oxygen was used routinely in hospitals by the 1940s. • Use of aerosolized medications for the treatment of asthma began in 1910, with numerous new drugs being developed in the 20th century and continuing up to the present. • Mechanical ventilation was explored in the 1800s. In 1928, Drinker developed his iron lung; this was followed by the Emerson iron lung in the 1930s, which was used extensively during the polio epidemics of the 1940s and 1950s, and the modern critical care ventilator, which became available in the 1960s. • The ITA was founded in 1947, becoming the AAIT in 1954, the AART in 1973, and the AARC in 1982. 55 Thank You