Predictions on Future Respiratory Care

Pierson, M.D.

Dr. Pierson reviews the history of respiratory care, both in the context of a subject area within clinical medicine and as a distinct health care profession. He then offers 10 predictions as to the likely changes that will be seen in the future. For example, there will be less focus on raising PaO2 as a primary goal in managing patients with acute hypoxemic respiratory failure. Also, more attention will be given to the adequacy of tissue oxygenation in such patients, irrespective of PaO2, and the emergence of "permissive hypoxemia,” analogous to permissive hypercapnia.

Smarter monitors will process information more extensively, predicts Dr. Pierson, and interact directly with ventilators and other devices to modify therapeutic interventions. Increased expertise will lead to more use of less-invasive ventilation in treating patients with acute exacerbations of chronic obstructive pulmonary disease (COPD), which will decrease intubations and complications. More triage will be used in the intensive care unit, with earlier determination of the appropriateness of maximal supportive intervention. In all clinical settings, there will be greater use of protocols in assessing and managing patients.

There will also be better awareness of the need for palliative care, which will be administered with improved expertise and resources, with respiratory therapists taking a more active role. Progress in smoking cessation and prevention will accelerate, as will the early detection and intervention in COPD, led by the respiratory care profession. Respiratory therapists will also have an increasing presence and impact as coordinators and care givers in home care. The last prediction is that the Respiratory Care journal will have a continued and enlarging role in disseminating information to those in the profession.