Appropriateness of respiratory care: evidence-based guidelines.

TitleAppropriateness of respiratory care: evidence-based guidelines.
Publication TypeJournal Article
Year of Publication2009
AuthorsRosière, J, Vader, J-P, Cavin, MSokol, Grant, K, Larcinese, A, Voellinger, R, Burnand, B, Revelly, JPierre, Fitting, JWilliam
JournalSwiss Med Wkly
Date Published2009 Jul 11
ISBN Number1424-7860
KeywordsEvidence-Based Medicine, Humans, Practice Guidelines as Topic, Respiratory Therapy, Respiratory Tract Diseases

PRINCIPLES: Respiratory care is universally recognised as useful, but its indications and practice vary markedly. In order to improve the appropriateness of respiratory care in our hospital, we developed evidence-based local guidelines in a collaborative effort involving physiotherapists, physicians and health service researchers.

METHODS: Recommendations were developed using the standardised RAND appropriateness method. A literature search was conducted based on terms associated with guidelines and with respiratory care. A working group prepared proposals for recommendations which were then independently rated by a multidisciplinary expert panel. All recommendations were then discussed in common and indications for procedures were rated confidentially a second time by the experts. The recommendations were then formulated on the basis of the level of evidence in the literature and on the consensus among these experts.

RESULTS: Recommendations were formulated for the following procedures: non-invasive ventilation, continuous positive airway pressure, intermittent positive pressure breathing, intrapulmonary percussive ventilation, mechanical insufflation-exsufflation, incentive spirometry, positive expiratory pressure, nasotracheal suctioning and non-instrumental airway clearance techniques. Each recommendation referred to a particular medical condition and was assigned to a hierarchical category based on the quality of the evidence from the literature supporting the recommendation and on the consensus among the experts.

CONCLUSION: Despite a marked heterogeneity of scientific evidence, the method used allowed us to develop commonly agreed local guidelines for respiratory care. In addition, this work fostered a closer relationship between physiotherapists and physicians in our institution.


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Alternate JournalSwiss Med Wkly
Citation Key / SERVAL ID2797
PubMed ID19629766


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