New Guidelines Target Mucus Clearance in Hospitalized Patients

There is currently a lack of evidence showing the benefit of certain therapies to clear mucus in the lungs when performed routinely in hospitals, according to the American Association for Respiratory Care (AARC).

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A team of experts conducted a systematic review to assess whether the use of non-pharmacologic airway clearance therapy (ACT) achieves the following: 1) improves oxygenation, 2) reduces time on the ventilator, 3) reduces intensive care unit length of stay, 4) resolves atelectasis/consolidation, or 5) improves respiratory mechanics compared to usual care in three specific hospital populations.

These guidelines have been published in efforts to reduce unnecessary care and potentially reduce hospital cost through elimination of unnecessary procedures.  The study “AARC Clinical Practice Guideline: Effectiveness of Nonpharmacologic Airway Clearance Techniques in Hospitalized Patients,” has been published online in Respiratory Care. Some of the key recommendations for the specific populations are as follows:

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 <270L/min

2) CPT, positive expiratory pressure, intrapulmonary percussive ventilation, and high frequency chest wall compression cannot be recommended due to insufficient evidence

For post-operative adult and pediatric patients:

1) Incentive spirometry is not recommended for routine, prophylactic use in post-operative patients

2) Early mobility and ambulation is recommended to reduce post-operative complications and promote airway clearance

3) ACT is not recommended for routine post-operative care

The guidelines also emphasize the need for further research into the effectiveness of these therapies. The full publication will follow in December in Respiratory Care.

For more information call (972) 243-2272 or visit AARC.org