Adult Critical Care Specialty (ACCS) is a certification offered by National Board of Respiratory Care (NBRC). This is a specialty examination developed for credentialing of respiratory therapists in acute care of adult patients. The certification is recognized and supported by various reputed organizations including American Association for Respiratory Care, American Society of Anesthesiologists, American College of Chest Physicians, and American Thoracic Society.
For being eligible to take this test, candidate must be holding Registered Respiratory Therapist (RRT) certification and should have one year of supervised experience in adult critical care. This experience is counted on behalf that candidate holds respective qualification i.e. MD, DO, or PHD and have practiced at least 21 hours per week in a year.
ACCS exam is breakdown into two major content areas-
Respiratory Critical Care: – Management of airways (Airway clearance techniques; Advanced techniques during intubation; Difficult airway recognition and techniques; Artificial airways); Management of ventilation (Initial settings; Noninvasive; Rescue techniques; Differential /independent lung ventilation; Optimizing patient-ventilator interaction; Advanced modes; Waveform analyses; Strategies: liberation from mechanical ventilation, management of ALI and ARDS, prevention of lung injury from mechanical ventilation, treatment of patients with traumatic injuries; Intrahospital transport of unstable and high-risk patients); Administration of specialty gases (Helium-oxygen; Nitric oxide); Delivering pharmacologic agents (Aerosolized agents other than bronchodilators; Airway instillations other than for ACLS).
General Critical Care: – Assessment of patient status and changes in status (Difficult airway issues: protection, thyromental distance, patency, mallampatti classification; Indices of respiratory physiology and mechanics: oxygenation, work of breathing, carbon dioxide clearance; Chest imaging: radiograph, CT, PET, ultrasound, MRI, V/Q; Neurologic: EEG, neuromuscular function, respiratory function, stroke, level of consciousness, seizures, brain death criteria; Hemodynamics: pre-load, after-load, contractility, rate control; Cardiovascular: physical assessment, systemic hypertension, diagnostic testing, coronary artery disease, arrhythmias, CHF, pulmonary hypertension; Recognition of respiratory failure mechanisms: acute lung injury and ARDS, atelectasis, hypoventilation syndromes, obstructive lung disease, post-operative, pulmonary edema, restrictive lung disease, transfusion-related lung injury, aspiration, drug induced, neuromuscular, pneumonia, pulmonary contusion, pulmonary embolism, sleep apnea, upper airway obstruction; Metabolic: respiratory quotient, endocrine disorders, nutrition/feeding, acid-base balance; Coagulation: indices, risk for deep vein thrombosis, platelet count; Differentiation among types of shock: anaphylactic, neurogenic, septic, hypovolemic, cardiogenic; Renal function: acid-base balance and fluid status; Gastrointestinal: abdominal distension, GI bleeding / endoscopy, feeding tube placement, ileus; Musculoskeletal: spinal cord injury, rhabdomyolysis, ICU myopathy); Anticipation of care according to imaging and reports of imaging (Plain radiographs: chest, spine, abdominal; MRI; Nuclear scans: V/Q lung, cerebral blood flow; CT: chest, brain, abdomen; Ultrasound: pleural, echocardiography, vascular; Angiography: pulmonary, gastrointestinal, coronary, bronchial); Care based on nutritional status (Complications of malnutrition: protein wasting, respiratory muscle catabolism, hypoglycemia; Route of feeding: enteral, parenteral; Metabolic study: caloric requirements, under-fed, exhaled gas analysis, over-fed; Complications of feedings: aspiration, malplacement of feeding tube, TPN line infection; Morbid obesity); Recognition and management of patients with infections and sepsis (Recognition of clinical and laboratory signs consistent with infections and sepsis: catheter-associated, pneumonia; Prevention measures: hand hygiene, skin integrity, catheter care; Management of patients with infections and sepsis: catheter-associated, pneumonia); Preparation for disasters (Procedures for patient movement and protection; Equipment and supply management; Triage procedures); Procedures (Arterial line insertion and monitoring; Mini-BAL); Care based on laboratory results (CBC; Electrolytes, magnesium, calcium, and phosphate; Coagulation studies; Cardiac markers: BNP, troponin; Acid-base status and lactate level; Culture and sensitivities: blood, urine, sputum, stool; Hemoximetry: methemoglobin, carboxyhemoglobin; Fluid analyses: pleural, peritoneal, CSF, urine; Sputum Gram stain; BUN and creatinine); Effects of pharmacologic agents (Sedatives / hypnotics; Neuromuscular blocking agents; Vasoactive and inotropic agents; Prophylaxis for stress ulcers, deep vein thrombosis, delirium; Drug interactions; Analgesia: systemic and regional; Reversal agents: naloxone, edrophonium, flumazenil, neostigmine; Drugs that induce methemoglobinemia: lidocaine, benzocaine spray, nitric oxide, nitroprusside, dapsone; Diuretics; Influence of co-morbid conditions); Prevention of ventilator associated pneumonia (Oral care; Ventilator circuit care: keeping closed, aerosol medication delivery, closed suction, heated wire/HME, optimal position; Bed position; Use of specialty airways: silver coated, subglottic suction endotracheal tube, polyurethane cuff; Minimizing intubation time: noninvasive positive pressure ventilation, aggressive weaning protocols); End-of-Life care (Differentiation of the potential need for end-of-life care: hospice and palliative; Withdrawal of life support; Determination of brain death; Care of organ donors); Interaction with members of interdisciplinary team (Response to modifications to the care plan from other team members; Suggested modifications to the care plan based on the respiratory assessment); Troubleshooting of systems (Chest tube drainage; Hemodynamic monitoring; Bronchoscopy; Inhaled vasodilator delivery: prostaglandins and nitric oxide).
This test covers content on following disorders- General disorders, COPD, Post-Surgical, Trauma, Shock, Immunocompromised, Bariatric disorders, Psychiatric disorders, ALI / ARDS, Cardiac disorders, Asthma, Neurologic disorders, Pulmonary Embolism, Pulmonary Hypertension, Burn / Inhalation Injury, and Cystic Fibrosis.
There are 170 multiple choice questions in exam, of which 150 are scored and 20 are unscored pretest questions. Unscored questions are randomly placed in test and can not be distinguished. Such questions are included to gather statistical data for future development of this exam. Out of 150 scored questions, 58 questions are related to respiratory critical care and 92 questions are related to general respiratory care. In respiratory critical care area, 10 questions belong to ‘Management of airways’, 4 questions belong to ‘Administration of specialty gases’, 40 questions belong to ‘Management of ventilation’, and 4 questions belong to ‘Delivering of pharmacologic agents’.
In general respiratory care, 27 questions belong to ‘Assessment of patient status and changes in status’, 10 questions belong to ‘Anticipation of care according to laboratory results’, 7 questions belong to ‘Anticipation of care according to imaging and reports of imaging’, 11 questions belong to ‘Effects of pharmacologic agents’, 4 questions belong to ‘Care based on nutritional status’, 7 questions belong to ‘Prevention of ventilator associated pneumonia’, 7 questions belong to ‘Recognition and management of patients with infections and sepsis’, 4 questions belong to ‘End-of-Life care’, 3 questions belong to ‘Preparation for disasters’, 3 questions belong to ‘Interaction with members of interdisciplinary team’, 2 questions belong to ‘Procedures’, and 7 questions belong to ‘Troubleshooting of systems’. Test takers get 4 hours to complete this examination.
The raw score in exam is equal to number of multiple choice questions attempted correctly. Since, there is no negative marking, examinees should try to attempt maximum questions and complete the entire test. This raw score is converted into a scaled score. The passing score is determined by modified Angoff method. Current scaled passing score is 75. Those candidates, who pass the exam, receive RRT-ACCS certification. The certification remains valid for a period of five years. Thereafter, it has to be renewed.
This exam is available on more than 170 assessment centers throughout United States and outside. It is offered on daily basis from Monday through Saturday. Candidates can apply for test by sending a completed application form along with examination fee and documents for eligibility verification to NBRC. They can also apply by completing an electronic application on NBRC website. The eligible candidates are notified by a confirmation letter containing information pertaining to scheduling of exam. Ineligible candidates are also informed and returned paid fees with reduction of $50 application processing fee. Candidates approved to take this test can schedule an appointment three days before any desired test date.
NBRC ACCS exam fee is as follow-
Initial certification: – $300
Re-examination: – $250