A new evidence-based Clinical Practice Guideline (CPG) published in Respiratory Care found that evidence is lacking that proves pharmacologic agents routinely administered for airway clearance are effective in improving oxygenation and respiratory mechanics, reducing ventilator time and ICU stay, or resolving atelectasis.
The CPG is based on the work of an American Association for Respiratory Care (AARC) task force and Vanderbilt University researchers.
“This guideline and the associated systematic review has laid out the evidence for and against some common practices in airway clearance. Our focus as providers should be to ensure that our patients are able to receive and use therapy that is proven effective, and reduce treatment burden of ineffective therapies,” said Bruce Rubin, MD, Professor at the Virginia Commonwealth University School of Medicine and Physician in Chief at Children’s Hospital of Richmond, and a member of the task force that wrote the CPG. “As a living document, it is acknowledged that these recommendations may change if well-conducted randomized clinical trials provide greater evidence of effectiveness.”
Based on the evidence, the guideline, titled, Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients, states:
- The routine use of aerosolized N-acetylcysteine to improve airway clearance is not recommended in hospitalized adult and pediatric patients.
- Aerosolized agents to change mucus biophysical properties or promote airway clearance are not recommended for adult or pediatric patients with neuromuscular disease, respiratory muscle weakness, or impaired cough.
- Mucolytics are not recommended to treat atelectasis in postoperative adult or pediatric patients, and the routine administration of bronchodilators to postoperative patients is not recommended.
- There is no high-level evidence related to the use of bronchodilators, mucolytics, mucokinetics, and novel therapy to promote airway clearance in the studied populations.
However, the guideline further recommends that “Clinical decision making should be based on individual patient need, response to therapy, and potential for harm. Future research should be designed carefully with regard to subject population, outcome measures, and intervention.”
The AARC has written a number of Clinical Practice Guidelines and undertook this particular project to assure that the profession was following evidence-based practices and not compromising quality of care delivered to patients. AARC was the sole sponsor of this project.
Frank Salvatore, AARC President, said, “We encourage all respiratory therapists, physicians, nurses and others interested in pulmonary health to take a look at this guideline and implement its recommendations to best benefit the patient.”