The American Association for Respiratory Care (AARC) commissioned a systematic review, and AARC committee members participated in the review process. As a collaborative effort, the AARC team and the Vanderbilt Evidence-based Practice Center (EPC) developed the key questions and inclusion and exclusion criteria and engaged in identification and review of abstracts. AARC members involved in the work were paired with EPC staff to maintain rigor and protect against bias. This team previously reviewed the benefits and harmful effects of non-pharmacologic airway clearance techniques in hospitalized subjects
Similar to what was described in the nonpharmacologic airway clearance therapy clinical practice guideline, no high-level evidence was available. Because the recommendations are based on low-level evidence, the guideline developers did not use a formal guideline development process. Rather, the recommendations are based on a consensus of the committee, informed by a systematic review of the literature and clinical experience. The systematic review helped frame the issues and allowed the identification of potential harmful effects.
Hospitalized Adult and Pediatric Patients without Cystic Fibrosis
- Recombinant human dornase alfa should not be used in adults and children with non-cystic fibrosis bronchiectasis.
- Routine use of bronchodilators to aid in secretion clearance is not recommended.
- Routine use of aerosolized N-acetylcysteine to improve airway clearance is not recommended.
Adult and Pediatric Patients with Neuromuscular Disease, Respiratory Muscle Weakness, or Impaired Cough
The use of aerosolized agents to change sputum physical properties or improve airway clearance cannot be recommended for patients with neuromuscular disease or weakness due to insufficient evidence.
Postoperative Adult and Pediatric Patients
- Mucolytics cannot be recommended for use in the treatment of atelectasis due to insufficient evidence.
- Routine administration of bronchodilators to postoperative patients is not recommended.
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Artical Source: Strickland SL, Rubin BK, Haas CF, Volsko TA, Drescher GS, O’Malley CA. AARC Clinical Practice Guideline: effectiveness of pharmacologic airway clearance therapies in hospitalized patients. Respir Care. 2015 Jul;60(7):1071-7. [63 references]