The Adult Critical Care Specialist examination is the National Board for Respiratory Care (NBRC) specialty examination for registered respiratory therapists who care for critically ill adults. Passing it adds the ACCS specialty designation to the Registered Respiratory Therapist credential — displayed as RRT-ACCS — and validates knowledge and skills beyond general respiratory care: advanced ventilation and oxygenation, airways, hemodynamics, sepsis, and the multi-system management of the critically ill adult. The PassProfessor Adult Critical Care Specialist program prepares RRTs for that examination.
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What this credential certifies
The ACCS is a specialty credential, not an entry credential. It sits on top of the Registered Respiratory Therapist (RRT) credential and certifies depth in one arena: adult critical care. NBRC describes the holder’s knowledge as going above and beyond general respiratory care activities to competencies unique to adult critical care — an increased ability to administer and manage technical devices and therapies such as selective pulmonary vasodilators, advanced pharmacology, and extracorporeal membrane oxygenation (ECMO). The examination was first administered in July 2012, and the roles its holders point to — ICU lead or supervisor, transport team membership, ECMO specialist practice — share the same setting: the bedside of a critically ill adult, inside an interprofessional team that reads the credential as a statement about what can be handed to that therapist.
Eligibility states the credential’s character in one line: the examination is available to respiratory care professionals who have earned the RRT credential and have held it for at least one year. There is no education-programme route around that requirement and no experience-hours alternative published for it — the RRT itself, held for a year, is the gate. Candidates should therefore read this page as addressed to practising RRTs; a therapist still on the CRT/RRT route is preparing for a different NBRC examination first, and the companion exam guide places that route correctly.
The examination at a glance
| Item | Verified position |
|---|---|
| Program | Adult Critical Care Specialist (ACCS) — specialty credential displayed with the RRT as RRT-ACCS |
| Certifying body | The National Board for Respiratory Care (NBRC) |
| Examination | 170 multiple-choice items (150 scored and 20 pretest) in 4 hours, computer-based; forms are assembled by a linear-on-the-fly system from the published content outline |
| Passing standard | NBRC does not publish a numeric pass mark for this examination in its candidate-facing material, so none is printed here |
| Eligibility | Hold the Registered Respiratory Therapist (RRT) credential and have held it for at least one year |
| Examination fees (body’s fees) | $300 for new applicants; $250 for re-applicants |
| Credential maintenance | NBRC credentials are maintained through the Credential Maintenance Program (CMP) on a five-year cycle |
| Content outline | NBRC Adult Critical Care Specialty Examination Detailed Content Outline, effective August 2026 — Respiratory Critical Care 80 scored items per form; General Critical Care 70 scored items per form |
| Administrator note | PassProfessor is independent and is not affiliated with NBRC |
What the examination covers
The current detailed content outline — effective August 2026 — divides the 150 scored items of each form into two content areas. The counts below are the outline’s published per-form item counts, and its cognitive architecture matters as much as its topics: across the form, recall items are a small minority, and application and analysis — the outline’s integration level — carry the paper. This is an examination about managing patients, assembled item by item from the outline’s specifications.
I. Respiratory Critical Care — 80 scored items per form.
Manage Airways — 24. Airway clearance techniques, non-pharmacologic and pharmacologic; difficult airway recognition and techniques; intubation techniques, including cricoid pressure, video laryngoscopy and the gum elastic bougie; and artificial airways in depth — specialty endotracheal tubes such as subglottic suction, double-lumen, wire-reinforced and RAE tubes, exchanging endotracheal tubes, and specialty tracheostomy tubes including speaking, extended-length and t-tubes.
Administer Specialty Inhalants — 4. Nitric oxide, helium-oxygen and nitrous oxide: utilisation of clinical protocols for initiation, weaning and liberation, and indications, contraindications and complications.
Apply Techniques to Enhance Ventilation, Oxygenation, or Synchrony — 48. The examination’s single largest block, at nearly a third of the scored form. Initial settings for any invasive or noninvasive technique; waveform analysis; rescue techniques — recruitment maneuvers, prone positioning with its indications, contraindications and complications, and extracorporeal life support including venovenous and venoarterial ECMO and extracorporeal carbon dioxide removal; strategies — liberation from invasive mechanical ventilation, prevention of lung injury from mechanical ventilation, participation in the care of patients meeting diagnostic criteria for ARDS, care of patients with traumatic injuries across head, cervical spine, chest, abdomen, long bone, burn and inhalation patterns, mobilisation, exercise and rehabilitation during ventilatory support, PEEP management, and pharmacologic sedation and neuromuscular blockade, including participation in the care of patients experiencing pain, agitation and delirium; differential or independent lung ventilation; and intrahospital transport of unstable and high-risk patients.
Deliver Pharmacologic Agents — 4. Aerosolised agents other than bronchodilators — vasodilators, heparin, tranexamic acid, antimicrobials — and airway instillations other than for ACLS, including epinephrine, prothrombotics and lidocaine.
II. General Critical Care — 70 scored items per form. Evaluate non-pulmonary systems to manage patient care (6) across neurologic, cardiovascular and hemodynamic, renal, metabolic, gastrointestinal, hematologic and musculoskeletal presentations; manage contributors to respiratory failure (15), from difficult airway predictors and indices of respiratory physiology and mechanics to the primary pulmonary etiologies — ARDS, aspiration, atelectasis, drug-induced injury, infectious diseases, mechanical obstruction, obstructive and restrictive lung disease, pulmonary embolism, pulmonary hypertension, sleep-disordered breathing and trauma; anticipate care based on laboratory results (9), imaging (4), the effects of pharmacologic agents (8), and nutritional status (2); manage patients with infections and/or sepsis (4); manage end-of-life care (3); plan for disaster, pandemic and mass casualty events (2); advise an interdisciplinary team on management of challenging cases (3); perform procedures (4) — arterial line insertion and removal, mini-BAL, esophageal probes, ultrasound assistance; troubleshoot systems (6) — chest tube drainage, bronchoscopy, hemodynamic monitoring, intra-aortic balloon pump, ventricular assist devices and ECMO circuits; and support continuous improvement (4) across the regulatory environment, policies and procedures, quality improvement, research and education. The companion exam guide works through each area in full.
What makes this examination demanding
The ACCS is demanding in a specific way: it examines the RRT as the critical care team’s respiratory specialist, which means its centre of gravity is not recall of respiratory therapy but judgement under integration. The outline’s own architecture proves it — the per-form specifications allocate the overwhelming majority of items to application, analysis and integration, with recall a small residue, and the largest single block is the 48-item ventilation, oxygenation and synchrony section, where a stem gives the candidate a patient, a ventilator, waveforms and a trajectory and asks for the next move. Layered around that core is the general critical care half of the credential: the specialist is examined on anticipating care from laboratories and imaging, on sepsis and shock physiology, on the pharmacology of sedation, analgesia, neuromuscular blockade and vasoactive support, and on systems far outside the lungs — because in the ICU the ventilator decision is inseparable from the hemodynamic, renal and neurologic picture. A strong general RRT who has not practised at this integration level meets an examination that keeps asking one question in different costumes: given everything true about this patient, what should the respiratory specialist do, anticipate, or advise next?
The route, in order
The route runs: earn the Registered Respiratory Therapist credential — and hold it for at least one year — apply to NBRC for the Adult Critical Care Specialty Examination, paying the examination fee ($300 for new applicants; $250 for re-applicants) — schedule and sit the four-hour, 170-item computer-based examination — and, on passing, display the specialty credential as RRT-ACCS and maintain it through NBRC’s Credential Maintenance Program on the five-year cycle that governs NBRC credentials. Two route notes belong in the open. First, the one-year RRT requirement is a holding requirement, not an experience-hours log: the gate is the credential and its anniversary. Second, nothing in the ACCS route substitutes for state licensure, which remains a separate state process; the credential is a national specialty attestation held alongside licensure, not a licence itself.
Staying credentialed: the Credential Maintenance Program
NBRC credentials are maintained through the Credential Maintenance Program (CMP), NBRC’s continuing-competency system, on a five-year cycle calculated from the credential’s issue. The CMP is built on periodic assessment: its design focuses assessment content on the tasks that change most rapidly and put the public at highest risk, with the detailed content outlines for the assessments drawn from the same task base as the credentialing examinations — for ACCS holders, the maintenance assessments sample the adult critical care task set across each year of the cycle, and NBRC publishes the ACCS assessment outline alongside the examination outline. The practical discipline follows the program’s design: maintenance is continuous across the five years rather than a single renewal event, and the holder who treats each year’s assessment as a small audit of current critical care practice — reviewing the outline, identifying the year’s weak areas, studying them — is using the CMP exactly as NBRC built it. Holders should confirm their individual CMP schedule, assessment windows and fees in their NBRC record, since the program’s particulars are administered per credential.
What the PassProfessor program will cover
The August 2026 outline, weighted as published. The program is built on NBRC’s current detailed content outline: ventilation, oxygenation and synchrony given its plurality at 48 items per form, airways at 24, and the general critical care systems taught at their full published weights — not as a survey appended to a ventilation course.
Integration as the trained skill. Because the outline prices recall cheaply and integration dearly, the program’s practice is scenario-built: waveform interpretation tied to setting changes, laboratory and imaging results tied to anticipated care, pharmacology tied to the ventilated patient’s whole picture, and troubleshooting — chest drainage, hemodynamic monitoring, balloon pumps, assist devices, ECMO circuits — practised as systems reasoning.
The specialist’s seat at the team table. Advising the interdisciplinary team on challenging cases, end-of-life care, disaster and mass casualty planning, and continuous improvement are small item counts with outsized distinctiveness — they are where the examination tests the specialist’s professional role rather than the therapist’s technique, and the program covers them explicitly.
Independence, stated plainly. PassProfessor is an independent preparation provider, not affiliated with NBRC. Completing this program confers no credential; NBRC alone credentials, and candidates apply to NBRC for the examination.
Tell me when enrollment opens. The Adult Critical Care Specialist program is in the works and enrollment is not yet open. Leave an email address and PassProfessor will write to you when the program is ready — and only about this program. No date is promised, because the program will open when it meets the standard described above, not before.
Frequently asked questions
Who is eligible for the ACCS examination?
Respiratory care professionals who have earned the Registered Respiratory Therapist (RRT) credential and have held it for at least one year. That holding requirement is the eligibility gate NBRC publishes for this specialty examination.
How many questions are on the examination, and how long does it take?
170 multiple-choice items — 150 scored and 20 pretest — in four hours. Forms are assembled by a linear-on-the-fly system from the published content outline’s specifications.
What score passes the ACCS examination?
NBRC does not publish a numeric pass mark for this examination in its candidate-facing material, so this page prints none. Candidates should treat any pass figure quoted by third-party material as unverified.
What does the examination cost?
NBRC’s fee is $300 for new applicants and $250 for re-applicants. Those are NBRC’s fees, not PassProfessor charges.
How is the scored examination divided?
Under the detailed content outline effective August 2026, each form carries 80 Respiratory Critical Care items and 70 General Critical Care items. Within Respiratory Critical Care: Manage Airways 24, Administer Specialty Inhalants 4, Apply Techniques to Enhance Ventilation, Oxygenation, or Synchrony 48, and Deliver Pharmacologic Agents 4.
Is the ACCS a licence?
No. It is a national specialty credential held alongside the RRT and displayed as RRT-ACCS. State licensure to practise respiratory care is a separate state process.
I hold the CRT but not yet the RRT. Can I sit the ACCS?
No. The RRT credential, held for at least one year, is required first. Therapists on the entry route sit NBRC’s entry-level examinations for the CRT/RRT credentials before any specialty examination.
How do I maintain the credential?
Through NBRC’s Credential Maintenance Program (CMP), the continuing-competency system for NBRC credentials, on a five-year cycle — built on periodic assessments focused on rapidly changing, high-risk content drawn from the same task base as the examination. Confirm your individual schedule and requirements in your NBRC record.
When was the ACCS first offered?
NBRC first administered the Adult Critical Care Specialist examination in July 2012.
Is PassProfessor affiliated with NBRC?
No. PassProfessor is an independent preparation provider. NBRC alone credentials, and applications are made to NBRC.
When does enrollment open?
The program is in the works and enrollment is not yet open. Leave an email address on this page and PassProfessor will write to you when the program is ready — and only about this program. The companion Adult Critical Care Specialist exam guide sets out the full content outline, area by area.