NBRC-ACCS Exam Information and Outline
Adult Critical Care Specialist
NBRC-ACCS Exam Syllabus & Study Guide
Before you start practicing with our exam simulator, it is essential to understand the official NBRC-ACCS exam objectives. This course outline serves as your roadmap, breaking down exactly which technical domains and skills will be tested. By reviewing the syllabus, you can identify your strengths and focus your study time on the areas where you need the most improvement.
The information below reflects the latest 2026 course contents as defined by NBRC. We provide this detailed breakdown to help you align your preparation with the actual exam format, ensuring there are no surprises on test day. Use this outline as a checklist to track your progress as you move through our practice question banks.
Below are complete topics detail with latest syllabus and course outline, that will help you good knowledge about exam objectives and topics that you have to prepare. These contents are covered in questions and answers pool of exam.
I. RESPIRATORY CRITICAL CARE
A. Manage Airways
- Airway clearance techniques
- Difficult airway recognition and techniques
- Advanced techniques during intubation (e.g., cricoid pressure, specialty visualization devices, tube changers)
- Artificial airways:
- Specialty endotracheal tubes (e.g., subglottic suction, double lumen, wire-reinforced)
- Exchanging endotracheal tubes
- Specialty tracheostomy tubes
B. Administer Specialty Gases
- Nitric oxide (initiation and withdrawal)
- Helium-oxygen (indications)
C. Manage Ventilation/Oxygenation
- Initial settings
- Advanced modes (techniques to enhance ventilation, oxygenation, and synchrony)
- Noninvasive ventilation (high flow nasal cannula, NPPV, mask CPAP)
- Waveform analyses
- Rescue techniques:
- Recruitment maneuvers
- Inhaled vasodilators (e.g., nitric oxide, prostacyclin)
- High frequency ventilation
- Prone patient positioning
- Extracorporeal life support (e.g., ECMO)
- Management strategies:
- Liberation (weaning) from mechanical ventilation
- Prevention of lung injury from mechanical ventilation
- Management of ARDS
- Treatment of patients with traumatic injuries (e.g., head, abdomen, cervical spine, long bone fractures, burn/inhalation, chest)
- Exercise and rehabilitation while receiving ventilatory support
- PEEP management (e.g., severe vs. mild hypoxemia)
- Differential / independent lung ventilation (indications and techniques)
- Intrahospital transport of unstable and high-risk patients
- Optimizing patient-ventilator interaction
D. Deliver Pharmacologic Agents
- Aerosolized agents other than bronchodilators (e.g., vasodilators, antimicrobials)
- Airway instillations other than for ACLS (e.g., epinephrine, cold saline, topical thrombin, lidocaine)
- Optimization of aerosol delivery (e.g., high flow nasal cannula, NPPV, during mechanical ventilation)
II. GENERAL CRITICAL CARE
A. Assess Patient Status and Changes in Status
- Difficult airway issues (e.g., patency, protection, thyromental distance, Mallampati classification)
- Chest imaging (e.g., radiograph, ultrasound, ventilation/perfusion scan, CT, echocardiograph)
- Indices of respiratory physiology and mechanics (e.g., oxygenation, ventilation, capnometry/capnography, work of breathing)
- Neurologic status (e.g., neuromuscular function, level of consciousness, brain death criteria, seizures, stroke, EEG)
- Cardiovascular status (e.g., physical assessment, coronary artery disease, dysrhythmias, systemic hypertension, CHF, diagnostic testing, pulmonary hypertension)
- Hemodynamics (e.g., preload, afterload, contractility, rate control, cardiac output, oxygen delivery)
- Differentiation among types of shock (e.g., hypovolemic, anaphylactic, cardiogenic, neurogenic, septic)
- Recognition of respiratory failure mechanisms:
- ARDS, aspiration, atelectasis, drug-induced, hypoventilation syndromes, neuromuscular, obstructive lung disease, pneumonia, post-surgical, pulmonary contusion, pulmonary edema (cardiogenic/noncardiogenic), pulmonary embolism, restrictive lung disease, sleep apnea, TRALI, and upper airway obstruction
- Renal function (e.g., fluid status, acid-base balance, acute kidney injury, urine output)
- Metabolic status (e.g., respiratory quotient, acid-base balance, nutrition/feeding, endocrine disorders)
- Gastrointestinal status (e.g., abdominal compartment syndrome, ileus, feeding tube placement, GI bleeding/endoscopy)
- Coagulation (e.g., indices, platelet count, risk for deep vein thrombosis)
- Musculoskeletal (e.g., spinal cord injury, rhabdomyolysis, ICU myopathy, muscle atrophy)
- Therapeutic hypothermia (e.g., targeted temperature management, methods, indications/contraindications, complications)
B. Anticipate Care Based on Laboratory Results
- Albumin, CBC (transfusion triggers/refusal), and Cardiac markers (troponin, BNP)
- Non-cardiac biomarkers (e.g., procalcitonin, d-dimer, lactate)
- Electrolytes (magnesium, calcium, phosphate) and Acid-base status (anion gap, ketones, lactate)
- Coagulation studies (PT, PTT, INR, platelets)
- Culture and sensitivities (blood, sputum, urine, stool) and Sputum Gram stain
- Hemoximetry (e.g., methemoglobin, carboxyhemoglobin)
- Endocrine assessment (thyroid function, cortisol, glucose) and BUN/Creatinine
- Liver function (e.g., bilirubin, ammonia, AST, ALT) and Fluid analyses (pleural, CSF, peritoneal, urine)
C. Anticipate Care Based on Imaging and/or Reports
- Plain radiographs (chest, spine, abdominal) and CT (brain, chest, abdomen)
- MRI and Ultrasound (lung, vascular, echocardiography, pleural, abdominal)
- Nuclear scans (V/Q, cerebral blood flow) and Angiography (pulmonary, coronary, bronchial, GI, cerebral)
D. Anticipate Effects of Pharmacologic Agents
- Sedatives / hypnotics (e.g., propofol, benzodiazepines, dexmedetomidine)
- Analgesia (e.g., opioids, ketamine)
- Neuromuscular blocking agents (e.g., vecuronium, succinylcholine, rocuronium, cisatracurium)
- Reversal agents (e.g., neostigmine, naloxone, flumazenil, sugammadex)
- Vasoactive and inotropic agents
- Drugs inducing methemoglobinemia (e.g., nitroprusside, lidocaine, nitric oxide)
- Prophylaxis (DVT, stress ulcers, delirium) and Diuretics
- Drug interactions and influence of co-morbid conditions (hepatic/renal failure)
E. Anticipate Care Based on Nutritional Status
- Complications of malnutrition (e.g., protein wasting, respiratory muscle catabolism, hypoglycemia)
- Complications of nutritional support (e.g., aspiration, tube malplacement, central line infection, refeeding syndrome)
- Route of feeding (parenteral vs. enteral) and Morbid obesity
- Metabolic studies (exhaled gas analysis, caloric requirements)
F. Prevent Ventilator-Associated Events
- Oral care, bed position, and minimizing intubation time (aggressive weaning, NPPV)
- Ventilator circuit care and use of specialty airways (subglottic suction, polyurethane cuffs)
- Assessment of cuff integrity and pressure
G. Recognize and Manage Patients with Infections and/or Sepsis
- Recognition of signs (catheter-associated, CBC, culture data)
- Management of infections/sepsis (e.g., pneumonia, catheter-associated)
- Prevention measures (PPE, standard/advanced precautions, isolation, skin integrity, catheter care)
H. Manage End-of-Life Care
- Types of care (hospice, palliative, advance directive)
- Determination of brain death and withdrawal of life support
- Care of organ donors
I. Prepare for Disaster and Mass Casualty Events
- Patient movement/protection procedures, triage, and equipment management
J. Interact with Members of an Interdisciplinary Team
- Suggested modifications to care plans based on respiratory assessment
- Response to modifications from other team members
K. Perform Procedures
- Arterial line insertion/monitoring, Mini-BAL, and Esophageal probes (transpulmonary pressure, NAVA)
L. Troubleshoot Systems
- Chest tube drainage, bronchoscopy, hemodynamic monitoring, and inhaled vasodilator delivery