American Association for Respiratory Care

Contributing to Evidence-Based CPG Continues AARC's Legacy of Embracing State-of-the-Art Respiratory Care

March 26, 2002
The American Association for Respiratory Care (AARC) has a long history of providing respiratory therapists and other health care providers with state-of-the-art, leading-edge guidelines. In 1991, the AARC published its first Clinical Practice Guidelines (CPGs) in its science journal, RESPIRATORY CARE.

To that end, AARC members have lent their expertise to a task force developed to produce an evidence-based practice guideline on ventilator weaning and discontinuation. Long-time AARC member and Associate Editor of RESPIRATORY CARE, Neil R. MacIntyre, MD, FAARC, chaired the Task Force put together by the AARC, the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM). The Task Force released its finding in the article entitled Evidence-Based Guidelines for Weaning and Discontinuing Ventilator Support, which appeared in the January 2002 issue of RESPIRATORY CARE.

Dr. MacIntyre, in his accompanying editorial, explained that the project was two-part. The first part was the McMaster University Evidence-Based Review of Weaning from Mechanical Ventilation, sponsored by the U.S. Agency for Health Care Policy and Research (AHCPR). The project yielded 154 studies deemed suitable for an evidence-based report from a multiple database search of more than 5,000 citations.

Following this initial analysis, the AARC, ACCP and SCCM put together a task force for the creation of a set of evidence-based clinical practice guidelines for ventilator weaning and discontinuation.

This new trend for evidence-based medicine has become the standard for developing CPGs, says Dean Hess, PhD, RRT, FAARC, consultant to the AARC CPG Committee.

"This means," Dr. Hess says, "that the CPG is based upon a systematic review of the literature and that there is a grading of the strength of the evidence upon which recommendations are made."

This approach, Hess says, ensures that:

The questions to be addressed by the CPG are formulated;

A thorough literature review is conducted;

The validity of the literature is assessed; and

Recommendations are made based upon the strength of the evidence.

"The Weaning CPG is evidence-based in the truest sense because it is based upon a systematic evidence-based review of the literature (all of which was published as a supplement to the December issue of Chest). Each recommendation is given a grade, which is determined by the strength of the evidence to support it," Hess says.

"Beginning this year, the AARC will be developing evidence-based CPGs, Hess adds. Every intention is to make these consistent with the principles of evidence-based medicine. Such principles can be reviewed in the November and December issues of RESPIRATORY CARE, in which are published the proceedings of a conference on the topic of evidence-based medicine."