The Contributions of Respiratory Therapists in the United States of America: A Scoping Review.

Respiratory therapists (RTs) provide essential care across the United States of America (USA) in various health care settings, with a prominent role in critical care. RTs specialize in managing mechanical ventilation, maintaining patent airways, and assisting with specialized procedures. While RTs in the USA have a broad scope of practice, it varies based on multiple factors; as a result, limited evidence exists detailing their specific roles and responsibilities. This review aims to map the breadth and depth of the available literature on RT practice in critical care within the USA. This review included three aims: (1) describe the practices and roles of RTs in adult critical care settings (including value-efficiency scores), (2) summarize the different RT models of care in critical care teams in the USA, and (3) investigate regional variations in RT practices in critical care across the USA. This scoping review was guided by the Joanna Briggs Institute methodology for scoping reviews. Studies that described the RT role in adult critical care within the USA were included. Data extraction was informed by the Respiratory Therapy Practice-Based Outcome Initiative (RT-PBOI) model and value-efficiency metrics. Eighty peer-reviewed articles and 45 pieces of grey literature met the inclusion criteria (total 125). RTs' roles and responsibilities were categorized per the RT-PBOI model as follows: Technical Skills (131), Approach to Practice (90), Leveraging Capacity (45), Strategic Expertise (73), and Growing Value for the Future (16). The grey literature (45) provided brief descriptions of the RT scope from various state regulatory/licensing bodies or state respiratory societies, guidelines, reports, and/or position statements. While RTs are crucial to critical care, gaps remain in quantifying their impact and clearly defining their evolving scope of practice. Further research is essential to optimize their integration into care teams, quantify impact, and improve patient outcomes.