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HORIZONS CREDENTIALING FOR THE RESPIRATORY CARE PROFESSION
Setting the Tidal Volume in Adults Receiving Mechanical Ventilation: Lessons Learned from Recent Investigations 3
NBRC Participates in AARC International Congress 6 Congratulations, AARC Fellows 6
Congratulations, AARC Honorary and Lifetime Members 7 2015 Annual Renewal 7
2014 NBRC Awards Presented at AARC International Congress 8
on
aduate
s:
: duates evel Gra 73.0 % es at id nd 24.9 % a t p e
en Examin
ation
tes Candida a p e
Examinat
ion
didates
w Can e p
e
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53.3 % 47.7%
t
ion Examinat
didates ew Can e a e p
ation T Examin
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71.0 % 45.2 % 69.3 %
Examination Statistics for the Fourth Quarter % of55.52014 10
69.5% 22.2 %
75.5% 25.1%
60.2 % 31.8 %
t
57.9 % 6.3%
50.0 % 9.4%
79.2 % 14.9 %
dates ndidates
c Oc t 1– De 31, 2014
c Oc t 1– De 31, 2013
c Oc t 1– De 31, 2012
60.7% 33.0 % 56.3 % 44.4%
64.6 % 48.3 % 61.1% %
32.1% 53.4% 48.4% 61.8 % 22.0 % 47.1% 50.0 %
From the NBRC President…
A
s I begin my second year as President of the Board of Trustees of the National Board for Respiratory Care, I am honored and humbled by the opportunity that was provided to me to lead the NBRC in 2014 and again in 2015. The NBRC takes the responsibility of serving the credentialing needs of this wonderful profession very seriously and the dedicated volunteers and staff work very hard to assure the examinations and processes continue to meet extremely high standards. 2014 was an extremely busy year for the NBRC. The year was spent preparing for the changes that were implemented January 15. The new Therapist MultipleChoice Examination replaced the CRT and Written RRT Examinations and combined them into one examination with two different cut scores. The new Clinical Simulation Examination was also released on January 15 and features more simulation problems that are half the length of the old simulation problems. These changes also required modifications to the free practice examinations and Self-Assessment Examinations, as well as adjusting all of the operational processes and procedures. Results from the Validation Studies for these new
exams were also documented. The Board of Trustees and examination committees have been working very hard to implement these significant changes for the last several years in order to better serve the respiratory care community. In addition to the work completed for the Therapist Multiple-Choice and Clinical Simulation Examinations, the dedicated examination committees reviewed and released seven examination forms into the computer testing network, completed a job analysis for the Sleep Disorders Specialty Examination, and started work on the practice examination and Self-Assessment Examination for the new Pulmonary Function Technology Examination that will be released in June 2015. This year will be equally busy for our examination committees. In addition to the ongoing committee work of reviewing and approving examination questions and examination forms, the committees will also be working to implement the new combined Pulmonary Function Technology Examination that combines the CPFT and RPFT Examinations into one multiple-choice examination with two different cut scores. This new
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HORIZONS
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FROM THE NBRC PRESIDENT … º CONTINUED FROM PAGE 1 examination will allow candidates the opportunity to earn two credentials while taking only one examination. In September, the NBRC Licensure Liaison Committee will host the 24th annual State Licensure Liaison Group meeting. Representatives from state licensure agencies will be invited to attend. This meeting, co-hosted with the American Association for Respiratory Care (AARC), has proved to be a very useful forum for discussing current challenges and issues that practitioners and state agencies face in the profession. This networking and learning opportunity has enabled the state respiratory therapy licensure agency representatives to understand the latest developments and to use that knowledge and contact with other leaders to implement leading edge innovations in credentialing. If you have already renewed your active status with the NBRC for 2015 – THANK YOU! If you have not, please do so. Some of you may wonder what you get for the $25 you spend to maintain your active status with the NBRC. Your fee for maintaining that status allows the NBRC to carry out its mission of promoting excellence in respiratory care by awarding credentials based on competence. Your continued support assists those newest members of our wonderful profession by maintaining the cost of the credentialing examinations at the lowest possible level for those who are just beginning their careers. Examination fees have not increased since computer based testing was
Published Quarterly by the NATIONAL BOARD FOR RESPIRATORY CARE, INC. 18000 W. 105th St. Olathe, Kansas 66061-7543 (913) 895-4900 Fax: (913) 895-4650 Email: nbrc-info@nbrc.org Website: www.nbrc.org NBRC Horizons is published quarterly to communicate information about the admission policies and procedures, the day-to-day activities, and the short-term and long-range plans of the National Board for Respiratory Care, the national certifying board for the respiratory care profession. The NBRC is sponsored by the American Association for Respiratory Care, the American Society of Anesthesiologists, the American Thoracic Society and the American College of Chest Physicians. Subscriptions to NBRC Horizons are free for active credentialed practitioners and $24 for inactive practitioners and others. Subscription forms can be obtained by contacting the NBRC Executive Office.
Copyright © 2015. The National Board for Respiratory Care, Inc. Permission must be secured in writing to reprint any portion of this issue. State societies for respiratory care, respiratory care education programs and state licensure agencies may reprint any portion of this publication in their newsletter provided they mention the source. EXECUTIVE COMMITTEE Carl F. Haas, MLS, RRT, RRT-ACCS, CPFT, FAARC (AARC), President Alan L. Plummer, MD, FCCP, FAARC (ATS), Vice President Linda A. Napoli, MBA, RRT, RRT-NPS, RPFT (AARC), Secretary Robert A. Balk, MD, FCCP (ACCP), Treasurer Kerry E. George, MEd, RRT, RRT-ACCS, FAARC (AARC), Past President PUBLIC ADVISOR Glenna L. Tinney, MSW MEMBERS-AT-LARGE Susan B. Blonshine, BS, RRT, RPFT, AE-C, FAARC (AARC) Robert L. Joyner, Jr., PhD, RRT, RRT-ACCS, FAARC (AARC) Stephen A. Stayer, MD (ASA)
initiated in 2000. What else can be purchased today for the same price that item or service cost in 2000? I strongly encourage each of you to demonstrate your professional commitment by renewing your active status with the NBRC for 2015. You can renew your status online at www.nbrc.org. In addition, if you are subject to the Continuing Competency Program (CCP), renewing your active status each year allows you to participate in the CCP at no additional cost! As an added incentive for renewing, every practitioner who renews receives the annual gift of appreciation. This year, the gift is a 2015 accordion style desk calendar. We hope you enjoy the incentive for renewing! To fund the research necessary to keep the credentialing examinations viable, as well as fund the professional development projects I have noted, your annual renewal fees are needed. Ensure your national credentials continue to have value and meaning by renewing your NBRC active or supporter status this year. Your support will be greatly appreciated and used by the NBRC to accomplish its mission in 2015 and beyond. Sincerely,
Carl F. Haas, MLS, RRT, RRT-ACCS, CPFT, FAARC 2015 NBRC President m
MEMBERS OF THE BOARD Doreen J. Addrizzo-Harris, MD, FCCP (ATS) Sherry L. Barnhart, RRT, RRT-NPS, FAARC (AARC) Todd G. Bocklage, MPA, RRT (AARC) Suzanne Bollig, RRT, RRT-SDS, RPSGT, R. EEG T., FAARC (AARC) William W. Burgin, Jr., MD, FCCP (ATS) Brian W. Carlin, MD, FCCP, FAARC (ACCP) Robin J. Elwood, MD, FAAP (ASA) Katherine L. Fedor, RRT, RRT-NPS, CPFT (AARC) Hyacinth M. Johnson, RN, BSN, MPA, RRT (AARC) Carl A. Kaplan, MD, FCCP (ACCP) David C. Levin, MD, FCCP (ATS) Robert A. May, MD, FCCP (ACCP) Omid G. Moayed, MD, MBA (ASA) Carl D. Mottram, BA, RRT, RPFT, FAARC (AARC) Theodora K. Nicholau, MD, PhD (ASA) Donald S. Prough, MD, FCCP (ASA) Gregg L. Ruppel, MEd, RRT, RPFT, FAARC (AARC) Robert A. Sinkin, MD, MPH, FAAP (ATS) Mark S. Siobal, BS, RRT, FAARC (AARC) David L. Vines, MHS, RRT, FAARC (AARC) Teresa A. Volsko, MHHS, RRT, FAARC (AARC)
TRUSTEE EMERITUS H. F. Helmholz Jr., MD, FAARC Robert M. Lawrence, MD Theodore Oslick, MD, FCCP, FAARC CHAIRMAN OF NBRC PUBLIC RELATIONS AND PUBLICATIONS COMMITTEE Carl Mottram, BA, RRT, RPFT, FAARC (AARC) STAFF Gary A. Smith, RRT (Hon), FAARC, Chief Executive Officer and Executive Director Lori M. Tinkler, MBA, Chief Operating Officer and Associate Executive Director Chelsea Earhart, MBA, Assistant Executive Director Robert C. Shaw Jr., PhD, RRT, FAARC, Assistant Executive Director Homer Rodriguez, RRT, Director, International Affairs Ami Bishop, Administrative Support Specialist Scott M. Hermansen, CPA, Chief Financial Officer Glenda Hocker, Executive Assistant Nancy Sachen, Administrative Assistant
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SETTING THE TIDAL VOLUME IN ADULTS RECEIVING MECHANICAL VENTILATION:
LESSONS LEARNED FROM RECENT INVESTIGATIONS Todd Bocklage, MPA, RRT Assistant Manager – Respiratory Care Services & Pulmonary Function Lab University of Missouri Health Care University Hospital & Women’s and Children’s Hospital Columbia, Missouri
J. Bailey Carter, MD Professor of Medicine Director – Division of Pulmonary and Critical Care Medicine Rush Medical College and Rush University Medical Center Chicago, IL
DISCLOSURE: Both authors are trustees of the National Board of Respiratory Care. Neither author has other real or potential conflicts of interest or other disclosures to declare.
INTRODUCTION Selecting the optimum tidal volume for adult patients on ventilatory support is critical to achieving the best clinical outcomes. Over the years, guidelines about tidal volumes have varied including times when sigh breaths were set to prevent the development of atelectasis. The purpose of this article is to describe the transition that examination committees have made over the last several years in which lung protection has become the primary goal when making decisions about mechanical ventilation.
VENTILATOR INDUCED LUNG INJURY Since the introduction of mechanical ventilatory support over 60 years ago, there has been an increasing body of evidence that this form of potentially life-saving support, may also be the source of further lung damage and have potential deleterious impact outside of the respiratory system.(1,2) Studies in a variety of experimental animals, using large tidal volumes and/or high inflation pressures demonstrated physiologic and pathologic changes similar to the diffuse alveolar damage seen in the acute respiratory distress syndrome, which was termed ventilator induced lung injury.(1) The comparable scenario in humans was termed ventilator associated lung injury by an international consensus conference.(3) The primary insult was overstretching the alveolus, either by large tidal volumes or excessive inspiratory plateau pressures (>30 cmH 2O) and was termed volutrauma and barotrauma, respectively.(2) In addition, the realization that systemic injury could also result from the elaboration of various inflammatory molecules, including reactive oxygen radicals and/or the translocation of bacteria or air into the systemic circulation to invoke a systemic inflammatory
Corresponding Author: Robert A. Balk, MD Division of Pulmonary and Critical Care Medicine Rush University Medical Center Chicago, IL
response was recognized as a potential cause of biotrauma. (2) The application of positive end-expiratory pressure (PEEP) was found to be protective in a number of experimental circumstances and could also prevent the shear stress injury associated with repetitive recruitment-derecruitment (termed atelectotrauma).(2) The concept of ventilator associated lung injury, or specifically damage from alveolar over-distention by large tidal volumes and/or elevated end-inspiratory plateau pressures challenged the common conventional ventilatory support practice of setting tidal volumes at 10-15 mL/kg measured body weight with a goal of achieving “normal values for acid base status, PaO2, and PaCO2. Recognition of this relationship gave rise to clinical investigations designed to evaluate whether outcome could be improved by limiting the potential for ventilator associated lung injury and using a lung protective ventilatory support strategy employing a smaller tidal volume and paying close attention to keeping the end-inspiratory plateau pressure under 30 cmH 2O.(4-8) Adopting the lung protective strategy would have to compromise the prior goals of ventilatory support. Primary emphasis is on maintaining adequate oxygenation, while accepting an increase in PaCO2 and resultant respiratory acidosis, as a consequence of the controlled hypoventilation or permissive hypercapnia.(4) This ventilatory support strategy had been utilized with obstructive airway disease to avoid dynamic hyperinflation and high levels of occult PEEP and resulted in improved outcomes compared to conventional ventilatory support.(9) In experimental models of lung injury there is evidence of decreased inflammation and lung water as a consequence of “therapeutic” hypercapnia.(10)
CLINICAL TRIALS IN ALI AND ARDS The adoption of lung protective ventilation strategies by clinicians was slowed by conflicting results from
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HORIZONS LESSONS LEARNED… º CONTINUED FROM PAGE 3 different studies that were published between 1994 and 1999. Hickling (4) and Amato (5) demonstrated improved survival while limiting tidal volume and inspiratory pressure. However, Brochard (7) and Brower (8) found no difference in outcome could be associated with similar ventilation strategies although Brower expressed concern that the study sample may have been too small, which could have underpowered statistical analyses. Finally, the seminal work of the ARDS network established by the National Heart Lung and Blood Institute of the National Institute of Health published the results of a large, prospective, multicentered trial of lung protective ventilatory support using tidal volumes of 6 mL/kg ideal body weight and end-inspiratory plateau pressures < 30 cmH 2O vs. 12 mL/kg ideal body weight and plateau pressure < 50 cmH 2O in 861 patients with acute lung injury or ARDS. (11) The trial was stopped early because of the impact on mortality. The large tidal volume group had significantly higher mortality (39.8% vs. 31.0%) and significantly fewer days of being alive and off of ventilatory support.(11) The beneficial response was noted in ARDS from various risk factors.(12) Subsequent network studies evaluated the benefits of higher and lower PEEP support, conservative vs. liberal fluid management, guidance of therapy based on central venous catheters vs. PA catheters, and continued to support the concept of providing lung protective ventilatory support to improve patient outcome.(13-15) Implementing lung protective ventilatory support for ARDS patients was also reported by other centers as a way to improve survival compared to historical controls.(16) These results changed the standard of care for ventilatory support for patients with ARDS and extended the concept of lung protective ventilatory support as the guiding principle for all forms of ventilatory support. The paradigm governing ventilatory support also switched from one of normalizing arterial blood gas results to one of maintaining “adequate oxygenation” and providing lung protection.
LUNG PROTECTION FOR EVERYONE The concept of protecting the lung from harm and from additional systemic insult by employing a lung protective ventilatory support strategy spread into other clinical scenarios. A meta-analysis published in 2009 concluded that low tidal volume ventilation was beneficial for patients with acute lung injury and ARDS.(17) In addition to the mortality benefits of lung protective ventilatory support, a meta-analysis of 20 publications (over 2,800 patients) found that the low tidal volume strategy was associated with decreased pulmonary infections and
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shorter hospital length of stay, despite the associated increase in PaCO2 and decrease in pH.(18) Using lung protective ventilation in 400 patients undergoing abdominal surgery who were judged to be at intermediate and high risk for developing post operative pulmonary complications resulted in significantly less major pulmonary and extra-pulmonary complications in the first seven days post surgery with the use of lung protective ventilation. (19) In addition, the lung protective ventilation group had less need for noninvasive ventilatory support , less need for invasive or noninvasive ventilatory support in the 30 day follow up period, and a shorter hospital stay. These findings have led some editorialists to suggest “low tidal volumes for all?”(20) Dr. Ferguson goes on to conclude that “in the ICU the ventilator should be set to a target tidal volume of 6-8 mL/kg in most patients receiving mechanical ventilation.”(20) If a patient’s spontaneous efforts result in a larger tidal volume than the volume provided by mandatory breaths, “should sedation or even paralytic agents be administered?” (20) This question sets the stage for future controversies.
DETERMINING IDEAL OR PREDICTED BODY WEIGHT As mentioned previously, the new paradigm is to use ideal body weight as opposed to actual patient weight. The ideal body weight is based on height as lung volume does not change based on gaining or losing weight. Ideal body weight is determined by a calculation by gender and height. The candidate is expected to know these formulas for calculating the ideal or predicted body weight in kg. Male: 50 + (0.91) [height (cm) – 152.4] or 50 + 2.3[height (inches) – 60] Female: 45.5 + (0.91) [height (cm) – 152.4] or 45.5 + 2.3[height (inches) – 60]
CONTROVERSY FOR THE FUTURE Recognizing the concepts of lung protective ventilatory support has given rise to debate over the potential of tidal volumes over 6-8 mL/kg to produce lung injury, even in the setting of low inflation pressures and/or spontaneous breathing efforts. Debates have been conducted to find agreement as to whether the stress response of a large tidal volume is equivalent in a normal versus an unhealthy lung. There is speculation whether a large volumes supported by low levels of pressure support will produce the negative outcomes that were described above. (21,22) Discussants have argued over the importance of volume vs. pressure for alveolar overdistention and the stress forces in the lung.(21,22) Dr. Gattinoni argues that the ideal tidal volume for a patient should be determined
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HORIZONS LESSONS LEARNED… º CONTINUED FROM PAGE 4 by measuring the lung volume and transpulmonary pressure (which is impractical in the critically ill patient).(22)
SUMMARY The convention of providing tidal volumes of 10 to 15 mL/kg of actual body weight regardless of airway pressure and aiming for normalization of arterial blood gases has been replaced by a new paradigm of lung protective ventilatory support. The maximum tidal volume has been dropped to 8 mL per kilogram ideal or predicted body weight based on the patient’s height and sex. Lung protection also places an equal importance on maintaining an end-inspiratory plateau pressure ≤ 30 cmH 2O to avoid alveolar overdistention and lowering the targeted tidal volume below 8 mL/kg if that pressure is exceeded. In the setting of ARDS, PEEP plays a therapeutic role in decreasing the potential for recruitment-derecruitment injury (atelectotrauma). Controversy continues as to whether increased tidal volumes or increased inflation
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pressures pose the greatest risk for lung injury and whether pressure controlled or volume controlled modes of ventilation offer distinct benefits. The jury is still out on this question, but the verdict is clearly one in favor of using lung protective ventilatory support. For now the goal of lung protection with set tidal volumes of 6-8 mL/kg ideal body weight seems to fit the right answer for just about everyone, but there will likely be refinements in the future. A candidate taking an NBRC examination should look for opportunities to use a lung protective strategy by delivering tidal volumes of no more than 8 mL/kg, holding plateau airway pressures below 30 cmH 2O, and including an appropriate PEEP level. If blood gases can be normalized at the same time, then do so. However, doing so is secondary to the volume and pressure limits. NBRC examination committees have migrated test content to follow these guidelines over the last several years. Our purpose in writing this article was to document this fact so that educators can be confident about guiding students’ learning in this area. m
REFERENCES 1. Dreyfuss D, Saumon G. Ventilator-induced lung injury: Lessons from experimental studies. Am J Respir Crit Care Med 1998;157:294-323. 2. Slutsky A and Ranieri M. Ventilator Induced Lung Injury. N Engl J Med. 2013; 369: 2126-2136. 3. International Consensus Conference Committee: International consensus conferences in intensive care medicine: Ventilatorassociated lung injury in ARDS. Am J Respir Crit Care Med. 1999;160:2118-2124. 4. Hickling KG, Walsh J, Henderson S. Jackson R. Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia: A prospective study. Crit Care Med 1994;22:1568-1578. 5. Amato MBP, Barbas CSV, Medeiros DM, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998;338:347-354. 6. Stewart TE, Meade MO, Cook DJ, et al. Evaluation of a ventilation strategy to prevent barotraumas in patients at high risk for acute respiratory distress syndrome. N Engl J Med 1998;338:355-361. 7. Brochard L, Roudot-Thoraval F, Roupie E, et al. tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. Am J Respir Crit Care Med 1998;158:1831-1838. 8. Brower RG, Shanholtz CB, Fessler HE, et al. Prospective, randomized, controlled clinical trial comparing traditional versus reduced tidal volume ventilation in acute respiratory
distress syndrome patients. Crit Care Med 1999;27:1492-1498. 9. Darioli R, Perret C. Mechanical controlled ventilation in status asthmaticus. Am Rev Respir Dis. 1984;129:385-387. 10. Laffey JG, Tanaka M, Engelberts D, et al. therapeutic hypercapnia reduces pulmonary and systemic injury following in vivo lung reperfusion. Am J Respir Crit Care Med 2000;162:2287-2294. 11. The Acute Respiratory Distress Syndrome Network (ARDSnet). Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome. N Engl J Med. 2000; 342:1301-1308. 12. Eisner MD, Thompson T, Hudson LD, et al. Efficacy of low tidal volume ventilation in patients with different clinical risk factors for acute lung injury and the acute respiratory distress syndrome. Am J Respir Crit Care Med. 2001;164:231-236. 13. Brower RG, Lanken PN, MacIntyre N, et al. for the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Higher versus lower positive end-expiratory pressure in patients with acute respiratory distress syndrome. N Engl J Med 2004;351:327-336. 14. The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Comparison of two fluid management strategies in acute lung injury. N Engl J Med 2006;354:2564-2575.
15. the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Pulmonary artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med 2006;354:2213-2224. 16. Kallet RH, Jasmer RM, Pittet JF, et al. Clinical implementation of the ARDS network protocol is associated with reduced hospital mortality compared with historical controls. Crit Care Med 2005;33:925-929. 17. Putensen C, Theuerkauf N, Zinserling J, et al. Meta-analysis: Ventilation strategies and outcomes of the acute respiratory distress syndrome and acute lung injury. Ann Int Med 2009;151:566-576. 18. Neto AS, Cardoso SO, Manetta JA, et al. Association between use of lung protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: A Meta Analysis. JAMA 2012; 308:1651-1659. 19. Futier E, Constantin JM, Paugam-Burtz C, et al. A trial of intraoperative low-tidal –volume ventilation in abdominal surgery. N Engl J Med 2013;369:428-437. 20. Ferguson ND. Low tidal volumes for all? JAMA 2012;308:1689-1690. 21. Hubmayr RD. Point: Is low tidal volume mechanical ventilation preferred for all patients on ventilation? Yes. Chest 2011;140:9-11. 22. Gattinoni L. Counterpoint: Is low tidal volume mechanical ventilation preferred for all patients on ventilation? No. Chest 2011;140:1113.
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NBRC PARTICIPATES IN AARC INTERNATIONAL CONGRESS The NBRC sponsored and participated in several important events during the 60th AARC International Respiratory Congress held December 9-12, 2014 in Las Vegas, Nevada. The Board of Trustees is excited about the future of respiratory care and continues to provide support for the profession by being well-represented at this significant meeting. A highlight of the 2014 AARC Congress was the annual NBRC Reception. This invitation-only event attracted several hundred leaders of the profession with the theme, “Celebrating Excellence in Credentialing.” During the reception, 2014 NBRC President Carl F. Haas, MLS, RRT, RRT-ACCS, CPFT, FAARC presented the 2014 Sister Mary Yvonne Jenn, CRNA, RRT Lifetime Achievement Award posthumously to Louis M. Sinopoli, EdD, RRT, AE-C, FAARC, recognizing his long record of outstanding service to the respiratory care profession. Louis’ wife, Joan Taylor, was present to accept this important honor. In addition, James A. Harvey, RPFT was presented the 2014 Robert H. Miller, RRT Award, given annually to a respiratory therapist or pulmonary function technologist who who has contributed significantly to the respiratory care credentialing system. During the awards ceremony at the AARC’s International Respiratory Congress, the NBRC presented the 2014 Albert H. Andrews Jr., MD Award to Thomas
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LAMBDA BETA SOCIETY SCHOLARSHIP RECIPIENTS (LEFT TO RIGHT) ZORANO SIPOS AND LILA FERNANDEZ
Fuhrman, MD, MMSc, FCCP. This award is given annually to a physician who has provided outstanding service to the respiratory care profession and the credentialing system. The AARC, CoARC, Lambda Beta Society, and the NBRC sponsored the annual “Student Survivor Hour,” a program designed especially for students enrolled in respiratory care education programs. NBRC Associate Executive Director, Lori M. Tinkler, MBA, greeted students and outlined information regarding
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CONGRATULATIONS, AARC FELLOWS
ixteen dedicated professionals were named Fellows of the American Association for Respiratory Care (FAARC) during the 2014 AARC International Respiratory Congress in Las Vegas, Nevada. The people in this group demonstrated excellence in key areas of the profession, ranging from management to education to research, and more. The NBRC congratulates the following new Fellows: Jenni L. Raake, RRT, RRT-NPS, FAARC Raymond Pisani, BS, RRT, RRT-NPS, FAARC Gene Andrews, BS, RRT, FAARC Denise M. Johnson, MA, RRT, FAARC Michael Scott Gibbons, BS, RRT, NRP, FAARC Floyd E. Boyer, BS, RRT, RCP, FAARC Douglas M. Pursley, MEd, RRT, RRT-ACCS, FAARC Joe Dwan, MSEd, RRT, RRT-ACCS, RRT-NPS, RRT-SDS, CPFT, RPSGT, FAARC
Lon W. Keim, MD, FACP, FACCP, FAARC Sue Ciarlariello, MBA, RRT, RRT-NPS, CMTE, RCP, FAARC John A. Rutkowski, MBA, MPA, RRT, FAARC Eileen M. Censullo, MBA, RRT, FAARC Georgianna G. Sergakis, PhD, RRT, FAARC Shane Keene, DHSc, RRT, RRT-NPS, CPFT, RPSGT, FAARC Jonathan Brady Scott, MS, RRT, RRT-ACCS, FAARC
Carl W. Willoughby, RRT, RCP, FAACVPR, FAARC
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HORIZONS NBRC PARTICIPATES… º CONTINUED FROM PAGE 6 the credentialing process. She gave a brief history of the organization and structure of the NBRC, and noted the many benefits derived from pursuit of the national respiratory care credentials. The AARC’s Associate Executive Director of Education, Shawna Strickland, PhD, RRT, RRT-NPS, FAARC, spoke about the role of the AARC in the respiratory care profession and the benefits and services that are available to AARC members. Sherry L. Barnhart, RRT, RRT-NPS, FAARC, spoke about the opportunities that Lambda Beta provides students. The NBRC continues to promote Student Survivor Hour as an excellent tool for helping those attending respiratory care education programs to learn about the professional organizations supporting the field and to gather information helpful to a successful educational experience and career. Attendees were then invited to attend the Lambda Beta Society reception immediately following the Student Survivor Hour presentation. During the reception, the $2,000 CoARC Steven P. Mikles, EdS, RRT, FAARC Media Award was presented to Lila Fernandez from Georgia State University in Conyers, Georgia. The $1,500 Applied Measurement Professionals, Inc. Scholarship was presented to Saido Abdirahman Abdulle from St. Catherine University in Woodbury, Minnesota. The $2,500 Lambda Beta Society Scholarship was awarded to Asma Alamoudi from Rush University in Chicago, Illinois,
CONGRATULATIONS, AARC HONORARY AND LIFETIME MEMBERS
D
ebra J. Fox, MBA, RRT, RRT-NPS, FAARC was awarded AARC Lifetime Membership, and Edna Fiore was awarded AARC Honorary Membership during the 2014 AARC International Respiratory Congress. The Jimmy A. Young Medal was awarded to Charles G. Durbin Jr., MD. The NBRC congratulates these individuals on these prestigious recognitions. m
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and the $1,000 Hill/Lambda Beta Society Scholarship was presented to Zorano Sipos from Concorde Career College in Huntington Beach, California. At the reception, Jana L. Anderson, Associate Executive Director and Director of Finance and Operation of CoARC, was awarded the distinction of a National Honorary Member for 2014. The reception was a great opportunity for the NBRC to interact with students and educators in the field of respiratory care. The NBRC also staffed a booth in the exhibit hall for the 60th AARC International Respiratory Congress and representatives enjoyed meeting and talking with many who had questions about the credentialing process. Considerable information about the upcoming CRT and RRT Examination changes and the Continuing Competency Program was provided. NBRC staff and Board members also received significant feedback about current issues. Through future participation in the AARC International Respiratory Congress, the NBRC plans to continue its efforts to communicate with and be accessible to the respiratory care community. We hope to see you in November at the 61st AARC International Congress in Tampa, Florida! m
ANNUAL RT E N E W A L 2015 Annual Renewal
he 2015 annual renewal process is underway! Annual renewal of active status is based on the calendar year, and the benefits of renewing your active status remains an excellent way to support your nationally recognized credential(s) and the achievement it represents. If you are not currently working in the profession, you may also renew your status as a supporter. To renew your active or supporter status for 2015, please visit the NBRC website at www.nbrc.org or contact the Candidate Support Center at (888) 341-4811. m
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2014 NBRC AWARDS PRESENTED AT AARC INTERNATIONAL CONGRESS Robert H. Miller, RRT, Award Presented to James A. Harvey, RPFT The NBRC Board of Trustees presents the Robert H. Miller, RRT Award annually to a respiratory therapist and/or pulmonary function technologist who has contributed significantly to the respiratory care credentialing system. The NBRC honored James A. Harvey, RPFT, with this award for 2014, and recognizes Mr. Harvey as a respected leader whose contributions to the NBRC and the credentialing system are extensive. Mr. Harvey spent the majority of his professional career at Stanford University Medical Center in the pulmonary physiology laboratory and served as a parttime instructor for nearly 40 years at various colleges and universities in the San Francisco Bay area. Because of research in which Jim was involved, the standard procedure for handling samples for blood gas analysis was fundamentally altered. Jim was appointed to the NBRC Board of Trustees in 1998 as a representative of the NSCPT and helped facilitate the transition of the NSCPT representatives to the AARC when the NSCPT went out of business. He continued to serve on the NBRC Board until 2009. During his time on the Board, Jim served as co-chair of the pulmonary function technology examination committee and as a member of the Executive Committee and Treasurer of the Board. Jim has authored and presented many papers and abstracts during his career and is now entering into his next phase of life â&#x20AC;&#x201C; retirement! Please join the NBRC Board of Trustees and staff in congratulating him on receiving the Robert H. Miller, RRT Award, and his many other outstanding accomplishments. The profession is fortunate to be able to benefit from his dedicated service and support.
Albert H. Andrews Jr., MD Award Presented to Thomas Fuhrman, MD, MMSc, FCCP The Albert H. Andrews Jr., MD Award is presented annually by the NBRC to a physician who has distinguished himself or herself through outstanding service to the respiratory care community. The Board of Trustees
ALBERT H. ANDREWS JR., MD AWARD PRESENTED TO THOMAS FUHRMAN, MD, MMSC, FCCP (CENTER) BY NBRC ASSOCIATE EXECUTIVE DIRECTOR LORI M. TINKLER (LEFT) AND NBRC PRESIDENT CARL F. HAAS (RIGHT)
was pleased to honor Thomas Fuhrman, MD, MMSc, FCCP, with this award for 2014. Dr. Fuhrman received the award during the AARC International Respiratory Congress Awards Ceremony in December 2014. Carl F. Haas, MLS, RRT, RRT-ACCS, CPFT, FAARC (AARC), and Chief Operating Officer and Associate Executive Director Lori M. Tinkler, MBA, presented the award on behalf of the NBRC Board of Trustees. Dr. Fuhrman has been very involved with the American Society of Anesthesiologists and the American College of Chest Physicians having served as the Chairman of the respiratory care steering committee for both of these organizations as well as numerous other roles. One of his biggest accomplishments is his 12 years of service to the NBRC. Dr. Fuhrman was a member of the Board of Trustees of the NBRC from 1999-2011, serving on the Executive Committee and as Vice President of the Board. He also chaired the Judicial and Ethics Committee and was the co-chair of the Therapist Written Examination Committee for seven years. Dr. Fuhrman brought a unique perspective to the NBRC having first
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2014 AWARDS PRESENTED … º CONTINUED FROM PAGE 8 been a respiratory therapist before earning his medical degree. The NBRC is delighted to add Thomas Fuhrman, MD, MMSc, FCCP, to the list of recipients of the Albert H. Andrews, Jr., MD Award. Without his unselfish dedication to respiratory therapy and those of other dedicated physicians, the respiratory care profession and its credentialing system would not enjoy the level of recognition and success that have been achieved today. Please join the NBRC in congratulating Dr. Fuhrman as the 2014 recipient of this significant award and on the numerous accomplishments he has achieved during his illustrious career.
Sister Mary Yvonne Jenn, CRNA, RRT Lifetime Achievement Award Presented to Louis M. Sinopoli, EdD, RRT, AE-C, FAARC The Sister Mary Yvonne Jenn, CRNA, RRT Lifetime Achievement Award is the NBRC’s highest honor, signifying tremendous contributions to the growth of respiratory care over a sustained period of time. It is presented by the NBRC to an individual whose career accomplishments have typically changed the direction of the profession or the NBRC’s credentialing system. The 2014 award was presented posthumously in memory of our dear friend and colleague, Louis M. Sinopoli, EdD, RRT, AE-C, FAARC. Dr. Sinopoli was the consummate respiratory care professional and dedicated his career to educating
FROM LEFT TO RIGHT: CARL F. HAAS, JOAN TAYLOR (ON BEHALF OF HER HUSBAND, LOUIS M. SINOPOLI), LORI M. TINKLER, AND JAMES A. HARVEY
students and advancing the profession across the globe. Louis earned his RRT in 1969 and held Registry #796. Renowned throughout respiratory care for his ability to innovate, Dr. Sinopoli will be remembered particularly for the work he did to advance respiratory care into the world of defensible, statistically validated competency examinations. Working with the NBRC, where he served as a member of the Board of Trustees for two terms (1974-77 and 1993-1996) and as a consultant over many years, he was instrumental in upgrading the quality of the respiratory therapist written examination, making it possible for the profession to move to the forefront of competency-based testing years ahead of similar professions. His efforts to pioneer criterion-referenced examinations resulted in him being the first respiratory therapist to chair the NBRC’s Therapist Written Examination Committee. Louis Sinopoli grew up in Bayonne, NJ, and first learned about the profession of respiratory care when his karate instructor, who was also a medical technologist, gave him a job in the inhalation therapy department at a local hospital. He fell in love with the profession and went on to earn his Bachelor of Science degree in respiratory care and instruction technology from the State University of New York, Empire State College in 1975. He taught in the RT program at Upstate Medical Center in Syracuse, NY, for seven years before moving to California, where he earned his doctorate from UCLA in 1981, specializing in research methods and evaluation. Louis was honored as the recipient of the NBRC’s Robert H. Miller , RRT Award in 1999 for his outstanding contribution to respiratory care and credentialing. Dr. Sinopoli’s final post in the profession was as program director and professor of the respiratory care program at El Camino College in Torrance, CA. Louis suffered a tragic accident at the 2013 AARC International Congress and later passed on January 8, 2014. Louis will always be remembered by his friends and colleagues on the NBRC as well as the many whose lives he touched throughout the respiratory care profession. Dr. Sinopoli’s extensive contributions to education and changing the face of the respiratory therapy profession made him uniquely qualified to receive the Sister Mary Yvonne Jenn, CRNA, RRT Lifetime Achievement Award. m
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EXAMINATION STATISTICS FOR THE FOURTH QUARTER OF 2014
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or the period of October 1, 2014 through December 31, 2014, the NBRC administered 9,628 credentialing examinations. A total of 2,905 new CRT, RRT, CPFT, RPFT, Neonatal/Pediatric Specialty, Sleep Disorders Specialty, and Adult Critical Care Specialty credentials were issued during the fourth quarter. Statistics for each NBRC examination are presented below:
CRT Examination One thousand nine hundred seventy-nine (1,979) candidates attempted the CRT Examination in the last three months of 2014, with 890 passing the examination to achieve the CRT credential. The total number of practitioners holding the CRT credential is 230,506.
RRT Examinations
The RRT Examination is a two-part credentialing process consisting of the Therapist Written Examination (WRRT) and the Clinical Simulation Examination (CSE). Three thousand seven hundred seventy-nine (3,779) individuals attempted the WRRT in the fourth quarter of 2014, while 3,262 took the CSE. A total of 1,620 candidates earned the RRT credential by passing both portions. The total number of RRTs (who are also CRTs) now stands at 141,875.
Pulmonary Function Technologist Examinations
The CPFT Examination was administered to 109 candidates during the fourth quarter of 2014. Of these individuals, 51 achieved a passing score and were awarded the Certified Pulmonary Function Technologist credential. From October 1, 2014 through December 31, 2014, 31 CPFTs attempted the RPFT Examination and 15 were awarded the advanced pulmonary function technologist designation. There are 13,043 individuals who hold the CPFT credential, and the total number of RPFTs (who are also CPFTs) is 4,365.
Neonatal/Pediatric Specialty Examination
During the fourth quarter, 242 CRTs and/or RRTs attempted the Neonatal/Pediatric Specialty Examination. One hundred sixty (160) individuals earned the credential, bringing the total number of CRT-NPS and/or RRT-NPS credentials awarded to 12,488.
Sleep Disorders Specialty Examination Nineteen (19) CRTs and/or RRTs attempted the Sleep Disorders Specialty Examination in the fourth quarter of 2014. Eighteen (18) individuals earned the credential, bringing the total number of CRTSDS and/or RRT-SDS credentials awarded by the NBRC to 315.
Adult Critical Care Specialty Examination Two hundred seven (207) individuals attempted the Adult Critical Care Specialty Examination in the fourth quarter of 2014, with 151 individuals passing the examination to achieve the RRTACCS credential. The total number of RRT-ACCS credentials awarded is 984. Please join the NBRC Board of Trustees and Executive Office staff in congratulating the individuals who achieved the 2,905 new credentials awarded by the NBRC in the fourth quarter of 2014! m
PASS RATES COMPARED Below are the passing percentages for NBRC credentialing examinations given in the fourth quarter of 2012, 2013, and 2014. Oct 1–Dec 31, 2012
Oct 1–Dec 31, 2013
Oct 1– Dec 31, 2014
New Candidates
79.2%
50.0%
57.9%
Repeat Candidates
14.9%
9.4%
6.3%
CRT Examination Entry-Level Graduates:
Advanced-Level Graduates: New Candidates
73.0%
75.5%
69.5%
Repeat Candidates
24.9%
25.1%
22.2%
New Candidates
60.2%
60.7%
55.5%
Repeat Candidates
31.8%
33.0%
32.1%
RRT Written Examination
RRT Clinical Simulation Examination New Candidates
53.3%
56.3%
53.4%
Repeat Candidates
47.7%
44.4%
48.4%
New Candidates
71.0%
64.6%
61.8%
Repeat Candidates
45.2%
48.3%
22.0%
69.3%
61.1%
47.1%
0.0%
25.0%
50.0%
CPFT Examination
RPFT Examination New Candidates Repeat Candidates
Neonatal/Pediatric Specialty Examination New Candidates
71.1%
65.1%
73.0%
Repeat Candidates
43.8%
35.0%
48.5%
Sleep Disorders Specialty Examination New Candidates
80.0%
100.0%
94.7%
Repeat Candidates
50.0%
0.0%
0.0%
Adult Critical Care Specialty Examination New Candidates
82.4%
86.6%
75.7%
Repeat Candidates
22.2%
36.4%
56.7%