Why simulation matters for RT. Respiratory therapy includes high-stakes, low-frequency clinical scenarios — pediatric respiratory arrest, ECMO circuit emergency, acute right heart failure on the vent, neonatal resuscitation — where competency cannot be built through routine clinical exposure alone. Simulation provides deliberate practice without patient risk, with structured debriefing that accelerates skill acquisition.
What the evidence shows. A 2024 systematic review in Respiratory Care found that simulation-based airway management training produced measurable improvements in intubation success rates and time-to-tube in both novice and experienced RT practitioners. The consistent finding across studies: simulation with structured debriefing produces better retention of low-frequency skills than didactic training alone.
What a department simulation program looks like. Most RT departments with active programs conduct quarterly skills days using mannequin-based simulations: sudden ventilator disconnect, pneumothorax recognition during ventilation, patient-circuit asynchrony diagnosis, and post-extubation emergency management. Debriefing — structured reflection after the scenario — is where the learning happens. Simulation without debriefing is practice. Simulation with debriefing is training.
How to start: Contact your nearest simulation center. Most hospitals with nursing or medical education programs have one. Propose a quarterly RT skills day using existing mannequin infrastructure. The incremental cost is low and the clinical benefit of quarterly high-stakes scenario rehearsal is significant.
The respiratory physiology of severe obesity. A patient with BMI above 40 has significantly altered respiratory mechanics: reduced FRC due to cephalad diaphragm displacement, increased closing volume that exceeds FRC in the supine position — meaning airways close during normal tidal breathing — increased work of breathing, and elevated oxygen consumption. On the ventilator, these mechanics produce a patient who is more difficult to oxygenate and more prone to atelectasis.
Ideal body weight and tidal volume — the critical calculation. Tidal volume in mechanical ventilation is calculated based on predicted ideal body weight — not actual body weight. This distinction is more important in bariatric patients than in any other population because the gap between actual and ideal body weight can be enormous. An RT who sets a bariatric patient's tidal volume based on actual body weight will ventilate with volumes 2 to 3 times appropriate. The IBW calculation must happen before the first breath.
Positioning and PEEP. Reverse Trendelenburg position — 30 to 45 degree head-up tilt — significantly improves oxygenation and reduces work of breathing in obese ventilated patients by allowing the diaphragm to descend freely. Higher PEEP — typically 10 to 15 cmH2O as a starting point rather than standard 5 cmH2O — is generally required for adequate alveolar recruitment.
The most common error: Calculating tidal volume using actual body weight in a severely obese patient. Make IBW calculation a mandatory first step in your ventilator setup checklist for any patient where actual and ideal weight are visibly discrepant.
What changed. CMS finalized the 2026 Medicare Physician Fee Schedule in November 2025 with updates to RT-relevant codes. Remote physiological monitoring codes (99453, 99454, 99457, 99458) had clarifying guidance confirming RT eligibility to bill independently under certain incident-to billing arrangements where permitted by state law.
The RPM revenue opportunity. CPT 99453 covers RPM device setup — $19.32 in 2026 Medicare rates. CPT 99454 covers monthly device supply and monitoring — $56.61 per month. CPT 99457 covers the first 20 minutes of RPM treatment management monthly — $51.61. A panel of 50 COPD patients in an RT-led RPM program generates approximately $6,400 per month in Medicare reimbursement.
What to check. Confirm whether your state scope of practice and Medicare billing rules allow RT-led RPM billing under your facility's structure. Confirm which CPT codes your department currently uses and whether all eligible encounters are captured.
Starting point: Request a meeting with your department director and the hospital's revenue cycle team. Bring the 2026 Medicare Physician Fee Schedule final rule from cms.gov. Revenue cycle teams respond to specificity — come with the code numbers and the rate table.
The event. The AARC International Respiratory Congress meets November 14 to 17, 2026 in New Orleans, Louisiana. It is the largest annual gathering of respiratory therapists in the world — several thousand practitioners, educators, and researchers across four days of clinical sessions, workshops, and the largest respiratory therapy exhibit hall in the industry.
What is on the 2026 agenda. Clinical sessions confirmed include advanced ventilator management, neonatal-perinatal critical care, sleep medicine updates, home mechanical ventilation, RT leadership and advocacy, and AI in respiratory care. The advocacy programming reflects the 2026 legislative environment — RCIC compact adoption, SOAR Act status, and APRT advancement are expected to be featured.
CRCE credit and the professional development case. The Congress offers more CRCE credit hours in four days than most RTs complete in six months through other channels. For practitioners approaching RRT renewal, the Congress is among the most efficient CE investments available.
Register now if you have not: aarc.org/congress. New Orleans hotels in the conference block sell out months in advance. Early registration rates end September 30. Submit your employer funding request now with the conference agenda as supporting documentation.
Next: The AARC 2026 Congress recap — what was discussed, announced, and what it means for RT practice in 2027.
Soon: Neonatal transport RT — the credential pathway and what the career looks like from practitioners doing it.
On deck: RT advocacy in 2027 — the legislative landscape after November 2026 and what RTs need to know.
Staying at the vent,
15 years across academic medical centers & community hospitals
