Evolving Roles of Nonphysician Respiratory Care Providers

Increasing evidence supports the efficacy of nonphysician allied health care practitioners (e.g., respiratory therapists, physicians assistants, and nurse practitioners) in providing care to patients with pulmonary/critical care medicine needs. This paper reviews the evidence regarding roles and clinical venues in which the impact of such allied health care providers has been examined. Evidence from several randomized controlled trials supports the efficacy of respiratory therapists and nurses in implementing weaning protocols to accelerate patients’ liberation from mechanical ventilation. Also, the results of two randomized controlled trials support the efficacy of respiratory therapists in allocating protocol-guided respiratory care services. In particular, such use of respiratory care protocols was associated with enhanced allocation of respiratory care compared with physician-directed care. Other roles for which allied health care providers have roles supported by observational experience include endotracheal intubation, placement of indwelling arterial catheters, performing bronchoscopic procedures, and staffing intensive care units as housestaff surrogates. Given the promise shown by some of the best designed studies, consideration of such roles for these allied health care providers should be considered as dictated by institutional need, and further well-designed studies to examine their efficacy in an expanded spectrum of roles is encouraged.