Respiratory therapist intubation is a routine part of airway care in many hospitals across Canada and the United States. Respiratory therapists (RTs) manage ventilators, assist with difficult airways and, in many settings, perform tracheal intubation themselves. Yet scope, training, and credentialing vary widely between provinces, states, and hospitals. This guide explains who can intubate, how RTs train, and what the evidence says about video laryngoscopy in RT practice.
What respiratory therapists do in airway care
RTs specialize in breathing and ventilation. In acute care, their work often includes:
- assessing and managing the airway,
- setting up and adjusting mechanical ventilation,
- supporting noninvasive ventilation and high-flow oxygen,
- assisting physicians during intubation,
- performing intubation where scope and credentialing allow,
- responding to cardiac arrests and rapid response calls.
Because RTs attend many emergencies, they are often at the bedside when an airway needs securing. For that reason, many hospitals rely on RTs as part of the airway team.
Respiratory therapist intubation in Canada
In Canada, intubation is a core skill for many respiratory therapists. Ontario offers a clear example.
Under Ontario’s Respiratory Therapy Act, intubation beyond the larynx is one of five controlled acts authorized to respiratory therapists, according to the College of Respiratory Therapists of Ontario. The College explains that this covers procedures such as endotracheal intubation and laryngeal mask insertion.
Hospitals then set local rules as well. Typically, a medical directive defines when an RRT may intubate, which patients qualify, and how the team documents and reviews each case.
Other provinces have their own regulators and rules. Therefore, RTs moving between provinces should check local scope and hospital policy before practicing.
Respiratory therapist intubation in the United States
The US picture is more varied. The American Association for Respiratory Care statement of scope of practice includes airway management among the services RTs provide.
However, state law and hospital credentialing decide whether an individual RT may intubate. In some hospitals, RTs intubate routinely, especially in neonatal units, emergency departments, and during cardiac arrests. In others, RTs assist while physicians, anesthesia providers, or advanced practice clinicians perform the procedure.
As a result, US hospitals that want RTs to intubate usually build a formal credentialing program. This often includes training, supervised cases, competency checks, and ongoing review.
What the evidence shows on respiratory therapist intubation
Meanwhile, research on RT intubation has grown in recent years. A multicenter study in Respiratory Care examined intubations performed by respiratory therapists across several hospitals.
The most common indications were cardiac arrest at 42% and respiratory failure at 31%. In other words, RTs often intubate in the most urgent situations.
The same study found that RTs used video laryngoscopy for 65% of initial attempts. Moreover, video laryngoscopy showed higher first-attempt success, higher overall success, and fewer adverse events.
An accompanying editorial titled “The Turf War Is Over” argued that the debate over whether RTs should intubate has moved on. Instead, the focus should be on training, competency, and the right equipment.
Why video laryngoscopy suits respiratory therapist intubation
Many RTs intubate less often than anesthesiologists. Consequently, any tool that improves first-attempt success has extra value.
Video laryngoscopy helps in several ways:
- Better views with less force, especially in difficult anatomy.
- Shared screen, so a supervisor can coach in real time.
- Recorded cases, which support review and credentialing.
- Consistent technique across neonatal, pediatric, and adult patients.
The wider evidence supports this. In the DEVICE trial, most operators had limited experience, yet first attempt success rose from 70.8% with direct laryngoscopy to 85.1% with video laryngoscopy.
For a full review, see our comparison of video laryngoscope vs direct laryngoscope.
Neonatal respiratory therapist intubation
In many Canadian and US neonatal units, RTs attend deliveries and perform neonatal intubation. Neonatal airways are small and anterior, and infants desaturate quickly, so skill matters.
Video laryngoscopy also helps teaching here. A 2023 review in the Canadian Journal of Respiratory Therapy looked at video laryngoscopy for teaching neonatal intubation. All included studies showed higher success with video laryngoscopy.
Of course, neonatal practice needs the smallest blades. Miller 00, 0, and 1 are common, as our laryngoscope blade size chart explains. For more detail, see our guide to video laryngoscopy for pediatric and neonatal intubation.
Respiratory therapist intubation during cardiac arrest
Cardiac arrest is the most common reason RTs intubate, so it deserves special attention. In these cases, the airway is only one part of a busy resuscitation.
First, the team should decide whether intubation is needed at all. Bag-mask ventilation or a supraglottic airway may be enough in the early minutes. Then, if the team chooses intubation, the operator should aim to avoid long pauses in chest compressions.
A video laryngoscope can help here. Because the operator watches a screen rather than lining up a direct view, many teams find it easier to work while compressions continue. In addition, the rest of the team can see progress on the screen and time any brief pause.
After placement, waveform capnography confirms the tube and also tracks the quality of compressions. Therefore, RTs often manage both the airway and the capnography trend during the code.
Finally, debriefing after a code helps the whole team improve. When the monitor records the laryngoscopy, RTs can review the view, the timing and any problems with colleagues afterwards. As a result, each cardiac arrest becomes a learning opportunity rather than a blur.
Building a respiratory therapist intubation program
Hospitals that expand RT intubation usually follow a structured plan.
- Define scope. Set out which patients and settings RTs may intubate in.
- Write a directive or protocol. Physician leaders and RT managers should agree on it together.
- Train on simulators. Start with manikin practice on the actual device.
- Supervise early cases. New intubators should complete a set number of supervised cases.
- Check competency. Use a standard assessment before independent practice.
- Maintain skills. Schedule regular refreshers, especially for low-volume staff.
- Review outcomes. Track first attempt success and adverse events for quality improvement.
Video recording supports several of these steps. Our article on video capture for airway management training explains how recorded laryngoscopy helps teaching and audit.
Equipment considerations for RT teams
RTs often carry airway equipment between units. So portability, battery life, and quick setup matter.
When choosing a device, RT departments should look for:
- a compact monitor that travels easily to codes and rapid responses,
- blades from neonatal to large adult sizes,
- a hyperangulated option for difficult airways,
- single-use blades for infection control during respiratory outbreaks,
- video recording for credentialing and review.
How Astra-vue supports respiratory therapists
Astra-vue offers one platform that covers neonatal to adult airways. Reusable Ultra Blades include Miller 000, 00, 0 and 1, Macintosh 1 to 4, and hyperangulated and channeled hyperangulated designs. For single-use workflows, the Pro Blade and the anti-fog Lite Blade are available.
The Mini Monitor has a 4-inch touchscreen, a 720p HD camera, and about 85 minutes of battery life. It records video and images to 16GB of storage, which supports credentialing and teaching. The system is FDA registered and listed, CE marked under MDR, and built under ISO 13485. See our products page or contact our team.
Respiratory therapist intubation FAQs
Can respiratory therapists intubate?
Yes, in many settings. In Ontario, intubation is a controlled act RRTs can perform. However, US practice depends on state law and hospital credentialing.
Do respiratory therapists use video laryngoscopes?
Often. For example, one multicenter study found RTs used video laryngoscopy for 65% of initial attempts, with higher first-attempt success.
How do respiratory therapists learn to intubate?
Training usually combines classroom teaching, simulation, supervised clinical cases, and competency checks, followed by regular refreshers.
Do respiratory therapists intubate newborns?
In many neonatal units, yes. RTs often attend deliveries and perform neonatal intubation under local protocols.
Why is video laryngoscopy useful for RT training?
A shared screen lets supervisors coach in real time, and recorded cases support review and credentialing.
