ACCS exam guide
About the Adult Critical Care Specialty (ACCS) exam
The NBRC Adult Critical Care Specialty examination measures advanced respiratory-therapy knowledge used with critically ill adults. The August 2026 outline integrates complex airway and ventilatory management with hemodynamics, neurologic, renal, metabolic, infectious, nutritional, ethical, procedural, quality, and systems-based critical care.
MedPorium is an independent education platform and is not affiliated with or endorsed by National Board for Respiratory Care (NBRC). Exam details can change; confirm them with the official source before applying.
ACCS exam format at a glance
- Questions
- 170
- 150 scored; 20 unscored
- Time
- 4 hours
- Delivery
- Computer-based testing at PSI assessment centers
Knowledge to review for the ACCS exam
These foundations support the practical tasks in the official examination matrix.
Advanced airway and ventilation
- Difficult-airway recognition, intubation adjuncts, specialty endotracheal and tracheostomy tubes, tube exchange, airway clearance, bronchoscopy, and transport
- Invasive and noninvasive settings, waveforms, patient-ventilator interaction, lung-protective ventilation, PEEP, recruitment, prone positioning, liberation, and VILI prevention
- ARDS, trauma, inhalation injury, obstructive and restrictive disease, pulmonary vascular disease, aerosolized therapies, nitric oxide, heliox, and airway instillation
Integrated adult critical care
- Neurologic status, seizures, stroke, ICP, temperature management, cardiac function, dysrhythmias, shock, preload, afterload, contractility, and coronary disease
- Renal failure and replacement therapy, acid-base and electrolyte disorders, nutrition, GI bleeding, hematology, anticoagulation, musculoskeletal disease, and infection
- Blood gases, biomarkers, cultures, fluid analysis, radiography, CT, MRI, ultrasound, hemodynamic monitoring, scoring systems, and physiologic indices
Therapies, systems, and professional practice
- Sedation, analgesia, neuromuscular blockade, reversal, vasoactive therapy, diuretics, anti-infectives, toxicities, and altered drug handling
- ECMO and ECCO2 removal, arterial and central monitoring, IABP and VAD support, chest tubes, mini-BAL, esophageal monitoring, NAVA, and procedural assistance
- Palliation, brain death, organ donation, disaster response, interdisciplinary care, device regulation, event reporting, quality improvement, research, and education
ACCS examination matrix
The percentages below are the approximate exam-score weights published by National Board for Respiratory Care (NBRC). Use them to allocate study time, then adjust for your own weak areas.
53.3%
RESPIRATORY CRITICAL CARE
The larger area covers advanced airway management, specialty gases and aerosols, mechanical ventilation, ARDS, trauma, extracorporeal support, mobility, transport, and liberation.
- Select and troubleshoot airway-clearance methods, difficult-airway techniques, specialty tubes, exchanges, and tracheostomy devices
- Initiate and optimize invasive or noninvasive ventilation using mechanics, waveforms, oxygenation, PEEP, positioning, sedation, and patient response
- Manage ARDS, trauma, specialty inhalants, extracorporeal support, transport, rehabilitation, liberation, and complications within respiratory-therapy scope
46.7%
GENERAL CRITICAL CARE
Integrate nonpulmonary critical illness, diagnostics, medications, nutrition, sepsis, procedures, end-of-life care, disaster response, regulation, and quality improvement.
- Interpret neurologic, cardiovascular, renal, metabolic, GI, hematologic, musculoskeletal, infectious, imaging, laboratory, and hemodynamic findings
- Recommend safe respiratory and interdisciplinary care based on pharmacology, nutrition, organ function, sepsis, shock, and evolving response
- Support monitoring and procedures, palliation and organ donation, disaster readiness, standards, device reporting, quality work, education, and evidence appraisal
How to use this ACCS diagnostic
The 15 questions sample both August 2026 content areas. For every miss, identify whether the gap involved airway or ventilation strategy, waveform or mechanics interpretation, oxygenation, extracorporeal support, another organ system, diagnostics, pharmacology, nutrition, sepsis, end-of-life care, disaster response, procedures, or professional practice.
High-yield ACCS study priorities
Priority 1
Use whole-patient respiratory decisions
Connect airway and ventilator choices with hemodynamics, neurologic injury, renal and metabolic compensation, abdominal pressure, nutrition, sedation, and mobility.
Priority 2
Interpret before adjusting
Practise integrating waveforms, mechanics, blood gases, imaging, hemodynamics, biomarkers, cultures, scoring systems, and bedside change before selecting an intervention.
Priority 3
Rehearse high-risk transitions
Focus on intubation, tube exchange, transport, proning, ECMO changes, spontaneous breathing trials, extubation, acute deterioration, and withdrawal of support.
Priority 4
Stay within advanced RT scope
Distinguish independent respiratory actions, protocol-driven changes, recommendations, procedure assistance, urgent escalation, and decisions requiring the broader critical-care team.
ACCS exam FAQ
How many questions are on the ACCS examination?
The current ACCS examination contains 170 multiple-choice questions: 150 scored items and 20 unscored pretest items.
How long is the ACCS examination?
Candidates currently have 4 hours to complete the examination.
Which ACCS outline does this guide use?
This guide follows the NBRC detailed content outline effective August 2026. Its scored weighting is approximately RESPIRATORY CRITICAL CARE 53.3%, GENERAL CRITICAL CARE 46.7%.
What is the largest ACCS content area?
RESPIRATORY CRITICAL CARE is the largest area at approximately 53.3% of scored content. Use that weighting to allocate study time without neglecting the remaining domains.
Who should verify eligibility for ACCS?
Candidates should verify the current credential, education, experience, application, and testing requirements directly with NBRC before applying. This study page does not determine eligibility.
Does this diagnostic predict whether I will pass?
No. A 15-question diagnostic is a low-confidence baseline, not a validated pass prediction. Review every rationale and confirm patterns with larger mixed and domain-specific sets.
Is MedPorium affiliated with NBRC?
No. MedPorium is an independent education platform and is not affiliated with or endorsed by the National Board for Respiratory Care.
Review and official source
Clinical reviewer: K. J. Arthur
Exam format and matrix information were checked against the NBRC ACCS examination page and detailed content outline. Source reviewed October 16, 2026.
Ready to check your ACCS knowledge?
Take the free 15-question practice test to identify strengths and topics that need more review.