AARC Clinical Practice Guideline: Effectiveness of Nonpharmacologic Airway Clearance Therapies in Hospitalized Patients

Abstract

Airway clearance therapy (ACT) is used in a variety of settings for a variety of ailments. These guidelines were developed from a systematic review with the purpose of determining whether the use of nonpharmacologic ACT improves oxygenation, reduces length of time on the ventilator, reduces stay in the ICU, resolves atelectasis/consolidation, and/or improves respiratory mechanics, versus usual care in 3 populations. For hospitalized, adult and pediatric patients without cystic fibrosis, 1) chest physiotherapy (CPT) is not recommended for the routine treatment of uncomplicated pneumonia; 2) ACT is not recommended for routine use in patients with COPD; 3) ACT may be considered in patients with COPD with symptomatic secretion retention, guided by patient preference, toleration, and effectiveness of therapy; 4) ACT is not recommended if the patient is able to mobilize secretions with cough, but instruction in effective cough technique may be useful. For adult and pediatric patients with neuromuscular disease, respiratory muscle weakness, or impaired cough, 1) cough assist techniques should be used in patients with neuromuscular disease, particularly when peak cough flow is < 270 L/min; CPT, positive expiratory pressure, intrapulmonary percussive ventilation, and high-frequency chest wall compression cannot be recommended, due to insufficient evidence. For postoperative adult and pediatric patients, 1) incentive spirometry is not recommended for routine, prophylactic use in postoperative patients, 2) early mobility and ambulation is recommended to reduce postoperative complications and promote airway clearance, 3) ACT is not recommended for routine postoperative care. The lack of available high-level evidence related to ACT should prompt the design and completion of properly designed studies to determine the appropriate role for these therapies.

AARC Clinical Practice Guideline: Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients

“…The medications considered are listed in Table 1. Similar to what was described in the nonpharmacologic airway clearance therapy clinical practice guideline, 6 no high-level evidence was available. Because the recommendations are based on low-level evidence, we did not use a formal guideline development process.…”

“…5 Developed in conjunction with the systematic review by Sathe et al, 5 this guideline is a companion to the 2013 AARC Clinical Practice Guideline. 6 The purpose of this guideline is to provide guidance to clinicians in the identification, selection, and delivery of medication for airway clearance. This guideline does not include the use of medication for patients with cystic fibrosis, as this has been addressed.…”

A review of blisters caused by wound dressing components: Can they impede post-operative rehabilitation and discharge?

“…The American Association for Respiratory Care (AARC) adds to accepted evidence that early ambulation is effective in reducing post-operative pulmonary complications (Strickland et al, 2013). Silva et al, (2013) state that high-risk patients, such as those undergoing high abdominal surgery, present with a greater need for more traditional pulmonary physiotherapy as a result of delayed mobility, augmenting the work of Haines et al, (2013), who suggest that patients who do not mobilise early following abdominal surgery are three times more likely to develop pulmonary complications for each day that mobilisation is delayed.…”

Correlation Between Lung Injury Score, PvO2/FiO2 Ratio and Oxidative Stress Markers in Tracheal Aspirate Samples in Intubated Infant Patients During Chest Physical Therapy

“…Standardized chest physical therapy (CPT) with postural drainage (PD), percussion, and vibration by hands before suction was performed under the clinical guideline of the American association for respiratory care (AARC) (5,23). All programs were treated by a specialized chest physical therapist that had more than 15 years' of experience.…”

“…Basic CPT techniques such as manual percussion, vibration on the chest wall, and postural drainage (PD) are performed commonly (4)(5)(6). Previous reviews evaluated the efficiency of CPT by duration of hospital stay, time to clinical resolution, lung sounds, chest X-ray, and cough frequency.…”