title: AARC Clinical Practice Guideline: Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients.
abstract: Aerosolized medications are used as airway clearance therapy to treat a variety of airway diseases. These guidelines were developed from a systematic review with the purpose of determining whether the use of these medications to promote airway clearance improves oxygenation and respiratory mechanics, reduces ventilator time and ICU stay, and/or resolves atelectasis/consolidation compared with usual care. Recombinant human dornase alfa should not be used in hospitalized adult and pediatric patients without cystic fibrosis. The routine use of bronchodilators to aid in secretion clearance is not recommended. The routine use of aerosolized N-acetylcysteine to improve airway clearance is not recommended. Aerosolized agents to change mucus biophysical properties or promote airway clearance are not recommended for adult or pediatric patients with neuromuscular disease, respiratory muscle weakness, or impaired cough. Mucolytics are not recommended to treat atelectasis in postoperative adult or pediatric patients, and the routine administration of bronchodilators to postoperative patients is not recommended. There is no high-level evidence related to the use of bronchodilators, mucolytics, mucokinetics, and novel therapy to promote airway clearance in these populations.
authors.affiliation: American Association for Respiratory Care, Irving, Texas. shawna.strickland@aarc.org.
authors.forename: Shawna L
authors.initials: SL
authors.lastname: Strickland
authors.affiliation: Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Rubin
authors.affiliation: University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Carl F
authors.initials: CF
authors.lastname: Haas
authors.affiliation: Department of Respiratory Care, Akron Children's Hospital, Akron, Ohio.
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Volsko
authors.affiliation: MedStar Washington Hospital Center, Washington DC.
authors.forename: Gail S
authors.initials: GS
authors.lastname: Drescher
authors.affiliation: Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: O'Malley
mesh_terms: D000293:Adolescent; D000328:Adult; D000336:Aerosols; D000368:Aged; D000369:Aged, 80 and over; D058109:Airway Management / Q000379:methods*; D000075202:Contraindications; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D009079:Mucociliary Clearance; D019141:Respiratory System Agents; D012138:Respiratory Therapy / Q000379:methods*; D055815:Young Adult
chemical_list: D000336:Aerosols; D019141:Respiratory System Agents
keywords: airway clearance therapies; heparin/N-acetylcysteine; mucokinetics; mucolytics; secretion clearance therapy