AARC clinical practice guideline: effectiveness of nonpharmacologic airway clearance therapies in hospitalized patients

The American Association for Respiratory Care (AARC) developed a guideline to determine whether airway clearance therapy (ACT) is effective over 3 hospitalized populations. A distinction was made between patients with: 
1) diverse lung conditions such as pneumonia, COPD or asthma (CF excluded). 
2) neuromuscular disease, respiratory muscle weakness or impaired cough. 
3) postoperative. 

Parameters were: 1) improved oxygenation 2) reduced time on the ventilator 3) reduced stay in the ICU 4) resolved atelectasis/consolidation 5) improved respiratory mechanics. 

Recommendations for the different groups are as follows: 

Group 1) 
· chest physiotherapy (CPT) is not recommended for the routine treatment of uncomplicated pneumonia 
· ACT is not recommended for routine use in patients with COPD 
· ACT may be considered in patients with COPD with symptomatic secretion retention 
· ACT is not recommended if the patient is able to mobilize secretions with cough, but instruction in effective cough technique may be useful. 

Group 2) 
· cough assist techniques should be used in patients with neuromuscular disease, particularly when peak cough flow is < 270 L/min 
· CPT, positive expiratory pressure (PEP), intrapulmonary percussive ventilation, and high-frequency chest wall compression cannot be recommended, due to insufficient evidence. 

Group 3: 
· incentive spirometry is not recommended for routine, prophylactic use in postoperative patients 
· early mobility and ambulation is recommended to reduce postoperative complications and promote airway clearance 
· ACT is not recommended for routine postoperative care. 

Take home message: Although commonly prescribed and valued by patients and clinicians, ACTs for hospitalized patients lack support from high-level studies. > From: Strickland et al., Respir Care 58 (2013) 2187-2193. All rights reserved to Daedalus Enterprises.

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