Loss of a Legend: Remembering Robert M. Kacmarek

On April 1, 2021, we lost our longest serving Editorial Board member, Robert M Kacmarek PhD RRT FAARC (Fig. 1). Bob joined the Editorial Board in 1985. Over the subsequent years, Bob contributed to the evolution of the Journal in many meaningful ways, as author, reviewer, and Editorial Board member. His tenure on the Editorial Board eclipsed 5 editors: Philip Kittredge, Pat Brougher, David Pierson, Dean Hess, and Richard Branson. He authored or co-authored 113 papers in the Journal between 1982 and 2021. ^1-113

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Fig. 1.

Robert M Kacmarek PhD RRT FAARC. February 5, 1949 – April 1, 2021.

Bob’s first publications in the Journal were a 3-part series on the technical aspects of PEEP. ^1-3 A co-author on those papers was Barry Shapiro, a physician and long-term supporter of the respiratory care profession until his death in 2008. Bob had a career-long interest in PEEP, and that had its genesis in these papers. Of note, in the early 1980s the use of PEEP was not common, and its use was controversial. It was a big deal to set PEEP on the ventilator back then. For respiratory therapists and critical care physicians practicing today, it is unthinkable that the ventilator could be set without PEEP, but it was common at that time. These papers on PEEP published in 1982 are classics and of interest even today, almost 40 years later.

The first Respiratory Care Journal Conference was in 1982. ¹¹⁴ Three years later, Bob presented 2 lectures at the 1985 conference on the topic of neonatal respiratory care. ^4,5 He participated in 17 Journal Conferences since 1985 (Fig. 2). It is noteworthy that Bob participated in the 1986 Journal Conference on mechanical ventilation ⁷ and the 1987 Journal Conference on PEEP. ⁹ Bob’s co-author on the PEEP paper ⁹ was the late Thomas L. Petty. Mechanical ventilation and PEEP are the subject areas around which Bob built his career.

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Fig. 2.

Respiratory Care Journal Conference. March 19–21, 2010. Bob Kacmarek is seen in second row, far left.

Although Bob authored many papers in the Journal related to invasive mechanical ventilation, he was not monolithic. He also wrote papers related to monitoring, ¹⁴ noninvasive ventilation, ^{13,14,39,40,46,50,58,63,64,74,77,79,102,109,112} inhaled nitric oxide, ^35,37,42 and aerosol therapy. ^15,22,27,90 Bob was one of the first to draw attention to the potential hazards to respiratory therapists related to secondhand aerosol inhalation. ¹⁵ Typical of Bob, not only did he identify a problem, but he also offered the solution. ¹⁵ His papers addressed many aspects of the professional practice of respiratory care. ^{1,4,26,60,62,65-68,73,76,103}

Bob presented scores of lectures as an invited speaker at the annual congress of the American Association for Respiratory Care. He is one of only 4 persons to present both the Philip Kittredge Memorial Lecture (1991; it was called the Program Committee Lecture at that time) and the Donald F. Egan Memorial Lecture (2010). The title of the first was “Respiratory Care Practitioner: Carpe Diem!,” ²⁶ in which Bob challenged the profession to “become true professionals—not factory workers working in hospitals.” Indeed, Bob followed his own challenge and built the respiratory care department at Massachusetts General Hospital in Boston into the preeminent department in the world, where respiratory therapists are clinical leaders at the bedside and respected members of the health care team. The “Carpe Diem” lecture also illustrated Bob’s humility. He admitted to not knowing the meaning of the term and sending his wife to the library to investigate its meaning. The title of the Egan Lecture was “The Mechanical Ventilator: Past, Present, and Future”; ⁶⁹ it might be the best history of mechanical ventilation written to date.

Bob’s passion for the respiratory care profession is best illustrated by his leadership on the AARC task force to identify new roles and responsibilities of respiratory therapists in the year 2015 and beyond. ^65-68,73,76 One of the recommendations of this task force was to require a baccalaureate degree for entry into the profession, and Bob became a fierce advocate for that standard. Bob possessed the courage of his convictions and fought hard, without apology for issues that he thought important.

The Open Forum is an important part of the annual congress of the American Association for Respiratory Care, where original research related to respiratory care is presented by respiratory therapists and others. ¹¹⁵ Bob first presented at the Open Forum in 1980 and contributed 74 Open Forum abstracts. He was a faithful and critical reviewer of submitted abstracts. The highlight of the careers of many young respiratory therapists was the opportunity to present an Open Forum abstract in a session chaired by Bob.

In addition to writing, one of Bob’s greatest loves was lecturing. He provided thousands of lectures on numerous topics locally, nationally, and internationally. He was a featured speaker for many professional societies, including scores of lectures at the annual congress of the AARC (Fig. 3). Bob lectured on 6 of the 7 continents and, for decades, was a worldwide ambassador for the respiratory care profession. He was always the strongest person in the room, and his presence was bigger than any room, regardless of the size. Bob Kacmarek had a profound impact on the respiratory care profession, and his influence is enduring. He will not be forgotten.

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Fig. 3.

AARC Congress. November 11, 2019. Bob Kacmarek (center) with Managing Editor Dean Hess (left) and Editor-in-Chief Richard Branson (at podium). Photograph courtesy of Carolyn J. LaVita.