Science and evidence: separating fact from fiction.
Evidence-based medicine (EBM) is the integration of individual clinical expertise with the best available research evidence from systematic research and the patient's values and expectations. A hierarchy of evidence can be used to assess the strength upon which clinical decisions are made. The efficient approach to finding the best evidence is to identify systematic reviews or evidence-based clinical practice guidelines. Respiratory therapies that evidence supports include noninvasive ventilation for appropriately selected patients, lung-protective ventilation, and ventilator discontinuation protocols. Evidence does not support use of weaning parameters, albuterol for ARDS, and high frequency oscillatory ventilation for adults. Therapy with equivocal evidence includes airway clearance, selection of an aerosol delivery device, and PEEP for ARDS. Although all tenets of EBM are not universally accepted, the principles of EBM nonetheless provide a valuable approach to respiratory care practice.
Department of Respiratory Care, Massachusetts General Hospital, and with the Department of Anesthesia, Harvard Medical School, Boston Massachusetts, and is the Editor in Chief of Respiratory Care.
Dean R
DR
Hess
D035843:Biomedical Research; D019317:Evidence-Based Medicine / Q000379:methods*; D006612:High-Frequency Ventilation / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic; D015272:Pulmonary Medicine / Q000379:methods*
clinical practice guideline; evidence-base medicine; meta-analysis; systematic review