Effectiveness of Nonpharmacologic Airway Clearance Therapies in Hospitalized Patients
Recommendations
Hospitalized Adult and Pediatric Patients Without Cystic Fibrosis
- 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, guided by patient preference, toleration, and effectiveness of therapy.
- ACT is not recommended if the patient is able to mobilize secretions with cough, but instruction in effective cough technique (eg, FET) may be useful.
Adult and Pediatric Patients With Neuromuscular Disease, Respiratory Muscle Weakness, or Impaired Cough
- Cough assist techniques should be used in patients with NMD, particularly when peak cough flow is <70 L/ min.
- CPT, PEP, IPV, and HFCWC cannot be recommended, due to insufficient evidence.
Postoperative Adult and Pediatric Patients
- 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.
ACT, airway clearance therapy; CPT, chest physiotherapy; CF, cystic fibrosis; CPD, FET, forced exhalation technique; HFCWC, high-frequency chest wall compression; IPV, intrapulmonary percussive ventilation; PEP, positive expiratory pressure
Recommendation Grading
Overview
Title
Effectiveness of Nonpharmacologic Airway Clearance Therapies in Hospitalized Patients
Authoring Organization
American Association for Respiratory Care
Publication Month/Year
June 1, 2014
Last Updated Month/Year
May 30, 2023
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
The purpose of this guideline, developed in conjunction with the systematic review by Andrews et al, is to provide guidance to clinicians in the identification, selection, and application of ACT techniques. These guidelines do not include the use of ACT in patients with cystic fibrosis (CF), as this has already been addressed.
Target Patient Population
Patients requiring airway clearance therapy
Inclusion Criteria
Female, Male, Adolescent, Adult, Child, Older adult
Health Care Settings
Emergency care, Hospital, Operating and recovery room
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Management, Treatment
Diseases/Conditions (MeSH)
D058109 - Airway Management, D001261 - Pulmonary Atelectasis, D005441 - Fluids and Secretions
Keywords
nonpharmacological treatment, nonpharmacologic, airway management, airway clearance therapy, ACT
Source Citation
Respir Care 2013;58(12):2187–2193.