Appropriateness of respiratory care: evidence-based guidelines.
BACKGROUND
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.


CONCLUSIONS
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.
Rosière
Joël
J
Department of Physiotherapy, Centre Hospitalier Universitaire Vaudois (CHUV), and University of Lausanne, Lausanne, Switzerland.
Vader
John Paul
JP
Cavin
Marta Sokol
MS
Grant
Kathleen
K
Larcinese
Anna
A
Voellinger
Rachel
R
Burnand
Bernard
B
Revelly
Jean Pierre
JP
Fitting
Jean William
JW
D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic; D012138:Respiratory Therapy / Q000592:standards*; D012140:Respiratory Tract Diseases / Q000628:therapy