77 Questions
According to the AARC Clinical Practice Guideline, what is the recommendation for chest physiotherapy (CPT) in hospitalized, adult and pediatric patients without cystic fibrosis and uncomplicated pneumonia?
CPT is not recommended for the routine treatment of uncomplicated pneumonia
In patients with COPD, what is the recommendation for the routine use of airway clearance therapy (ACT), according to the guideline?
ACT is not recommended for routine use in patients with COPD
When is airway clearance therapy (ACT) recommended in patients with COPD, according to the guideline?
ACT may be considered in patients with COPD with symptomatic secretion retention, guided by patient preference, toleration, and effectiveness of therapy
What is the recommendation for airway clearance therapy (ACT) in patients who are able to mobilize secretions with cough, according to the guideline?
ACT is not recommended if the patient is able to mobilize secretions with cough, but instruction in effective cough technique may be useful
What is the purpose of the AARC Clinical Practice Guideline on nonpharmacologic airway clearance therapies in hospitalized patients?
To determine whether the use of nonpharmacologic ACT improves oxygenation, reduces length of time on the ventilator, reduces stay in the ICU, resolves atelectasis/consolidation, and/or improves respiratory mechanics
What is the purpose of airway clearance therapy (ACT)?
To aid secretion mobilization and expectoration
In which patients is incentive spirometry not recommended for routine, prophylactic use?
Postoperative patients
What is the recommended peak cough flow for considering the use of cough assist techniques in patients with neuromuscular disease?
$<270$ L/min
What is the role of the mucociliary escalator and cough reflex in the respiratory system?
To defend the respiratory system by facilitating secretion clearance
Who is responsible for recommending, performing, and educating patients and families on airway clearance therapy (ACT)?
Respiratory therapists, physical therapists, and nurses
Which airway clearance therapy (ACT) is cautiously recommended for children with weak cough and strongly recommended in patients with Duchenne muscular dystrophy?
Mechanical insufflation-exsufflation
In which patient population is the use of chest physiotherapy (CPT) not recommended for routine treatment of uncomplicated pneumonia?
Patients with COPD
What is the peak cough flow threshold for considering the use of cough assist techniques in patients with neuromuscular disease (NMD)?
Less than 270 L/min
Which nonpharmacologic airway clearance therapy (ACT) may decrease ICU stay for non-intubated patients with COPD, but lacks sufficient high-level evidence to support a recommendation for this therapy?
Intrapulmonary percussive ventilation (IPV)
What is a well-known cause of morbidity and mortality in patients with neuromuscular disease (NMD)?
Pulmonary complications
What is the approximate percentage of patients with normal preoperative lung function who experience postoperative pulmonary complications?
7%
Which factor puts patients at increased risk for postoperative pulmonary complications?
History of smoking
What is the main cause of increased mortality related to postoperative pulmonary complications?
Pneumonia
Which therapy is commonly ordered for postoperative patients at risk for complications, despite recent meta-analyses showing no evidence of benefit in certain surgeries?
Incentive spirometry
What do recent reviews conclude about routine physiotherapy and lung expansion interventions for postoperative patients?
They are not justified for postoperative patients
Which statement best reflects the approach to airway clearance therapy for non-cystic fibrosis hospitalized patients?
Routine delivery of airway clearance techniques to non-cystic fibrosis hospitalized patients cannot be supported due to lack of evidence of significant benefit.
What is the recommended approach for airway clearance techniques in the setting of atelectasis without retained airway secretions?
The use of airway clearance techniques in the setting of atelectasis without retained airway secretions does not appear to be effective, especially in the setting of upper abdominal and thoracic incisions.
What is the stance on routine delivery of airway clearance techniques to non-cystic fibrosis hospitalized patients?
Routine delivery of airway clearance techniques to non-cystic fibrosis hospitalized patients cannot be supported due to lack of evidence of significant benefit.
What is the recommended approach post upper abdominal and thoracic surgery?
Avoidance of pulmonary complications is the prudent approach post upper abdominal and thoracic surgery, and routine use of incentive spirometry cannot be supported.
What is the stance on the use of CPAP by face mask for postoperative complications?
CPAP by face mask can alleviate hypoxemia due to low tidal volumes and airway obstruction, and may avoid reintubation, but there is no evidence to support routine use for the prevention of postoperative complications.
According to the AARC Clinical Practice Guideline, what is the recommendation for the routine use of chest physiotherapy (CPT) in hospitalized, adult and pediatric patients without cystic fibrosis and uncomplicated pneumonia?
CPT is not recommended for the routine treatment of uncomplicated pneumonia
In patients with COPD, what is the recommendation for the routine use of airway clearance therapy (ACT), according to the guideline?
ACT is not recommended for routine use in patients with COPD
What is the recommendation for the routine use of incentive spirometry in hospitalized, adult and pediatric patients without cystic fibrosis?
Incentive spirometry is not recommended for routine, prophylactic use
When is airway clearance therapy (ACT) recommended in patients with COPD, according to the guideline?
ACT may be considered in patients with COPD with symptomatic secretion retention, guided by patient preference, toleration, and effectiveness of therapy
What is the approximate peak cough flow threshold for considering the use of cough assist techniques in patients with neuromuscular disease (NMD)?
Less than 270 L/min
Which airway clearance therapy (ACT) is cautiously recommended for children with weak cough and strongly recommended in patients with Duchenne muscular dystrophy?
Mechanical insufflation-exsufflation
What is the stance on the routine use of chest physiotherapy (CPT) in patients with uncomplicated pneumonia?
Not recommended
In which patient population is the use of airway clearance therapy (ACT) not recommended for routine use, according to the guideline?
Patients with COPD
What is the main cause of increased mortality in patients with neuromuscular disease (NMD)?
Pulmonary complications
What is the stance on the use of incentive spirometry for routine, prophylactic use?
Not recommended
What is the recommended approach for airway clearance techniques in the setting of atelectasis without retained airway secretions?
No specific recommendation
What is the purpose of airway clearance therapy (ACT)?
To mobilize and remove respiratory secretions
What is the stance on the routine use of airway clearance therapy (ACT) in hospitalized patients without cystic fibrosis?
Minimal evidence to support routine use
What is the stance on the use of continuous positive airway pressure (CPAP) by face mask for postoperative complications?
Not recommended
What do recent reviews conclude about routine physiotherapy and lung expansion interventions for postoperative patients?
No evidence of benefit
What is the approximate percentage of patients with normal preoperative lung function who experience postoperative pulmonary complications?
Around 10%
What is the approximate percentage of postoperative patients with normal preoperative lung function who experience pulmonary complications?
7%
Which factor puts patients at increased risk for postoperative pulmonary complications?
History of smoking
Which therapy is commonly ordered for postoperative patients at risk for complications, despite recent meta-analyses showing no evidence of benefit in certain surgeries?
Incentive spirometry
What is the main cause of increased mortality related to postoperative pulmonary complications?
Pneumonia
What is the conclusion of recent reviews about routine physiotherapy and lung expansion interventions for postoperative patients?
Routine interventions may not be justified
What did the systematic review of randomized controlled trials find about airway clearance therapies (ACTs) for individuals without cystic fibrosis?
ACTs provide small benefits in pulmonary function, gas exchange, and oxygenation
What is the stance on routine airway clearance therapy in postoperative patients, mechanically ventilated patients, or patients with COPD?
Not recommended
What did studies on positive expiratory pressure (PEP) therapy show?
No evidence supporting its use in this population
What did studies on chest physiotherapy (CPT) demonstrate in relation to postoperative pulmonary complications?
No reduction in the incidence of complications
What is the conclusion about the effectiveness of nonpharmacologic airway clearance therapies in postoperative patients?
There is a lack of high-level evidence to support any airway clearance therapy (ACT) in postoperative patients
What is the recommendation for routine physiotherapy and lung expansion interventions for postoperative patients?
May not be justified for postoperative patients
What is the conclusion about the use of cough assist techniques in patients with neuromuscular disease (NMD)?
Recommended only for patients with weak cough
What is the peak cough flow threshold for considering the use of cough assist techniques in patients with neuromuscular disease (NMD)?
Less than 270 L/min
What is the stance on the routine use of airway clearance therapy (ACT) in patients with COPD, according to the guideline?
It lacks sufficient high-level evidence to support a recommendation
What is the recommendation for chest physiotherapy (CPT) in hospitalized, adult and pediatric patients without cystic fibrosis and uncomplicated pneumonia?
Not recommended for routine treatment
What is the purpose of the AARC Clinical Practice Guideline on nonpharmacologic airway clearance therapies in hospitalized patients?
To provide guidance to clinicians in the identification, selection, and application of ACT techniques
Who is responsible for recommending, performing, and educating patients and families on airway clearance therapy (ACT)?
Respiratory therapists, physical therapists, and nurses
What is the role of the mucociliary escalator and cough reflex in the respiratory system?
Facilitate secretion clearance and prevent airways obstruction
What is the approximate percentage of patients with normal preoperative lung function who experience postoperative pulmonary complications?
Around 10%
What is the stance on the use of CPAP by face mask for postoperative complications?
Not mentioned in the guideline
In which patient population is incentive spirometry not recommended for routine, prophylactic use?
Postoperative patients
What is the stance on the routine delivery of airway clearance techniques to non-cystic fibrosis hospitalized patients?
It is cautiously recommended
What is the recommended approach for airway clearance techniques in the setting of atelectasis without retained airway secretions?
Not recommended
What is the stance on the use of chest physiotherapy (CPT) for patients with cystic fibrosis?
Not included in the guideline
What is the stance on routine delivery of airway clearance techniques to non-cystic fibrosis hospitalized patients?
It is not recommended due to lack of evidence of significant benefit.
What is the recommended approach post upper abdominal and thoracic surgery?
Avoidance of pulmonary complications
What is the purpose of airway clearance therapy (ACT)?
To mobilize secretions and improve gas exchange
What is the recommended peak cough flow for considering the use of cough assist techniques in patients with neuromuscular disease?
<270 L/min
What is the approximate percentage of patients with normal preoperative lung function who experience postoperative pulmonary complications?
20%
In which patient population is the use of chest physiotherapy (CPT) not recommended for routine treatment of uncomplicated pneumonia?
Pediatric patients
What is the role of the mucociliary escalator and cough reflex in the respiratory system?
To clear airway secretions and maintain lung health
What is the stance on the use of CPAP by face mask for postoperative complications?
It is not recommended due to lack of evidence
Which statement best reflects the approach to airway clearance therapy for non-cystic fibrosis hospitalized patients?
It should be cautiously considered based on clinical judgment.
What is the recommendation for airway clearance therapy (ACT) in patients who are able to mobilize secretions with cough, according to the guideline?
It should be cautiously considered based on clinical judgment.
What is the purpose of the AARC Clinical Practice Guideline on nonpharmacologic airway clearance therapies in hospitalized patients?
To provide evidence-based recommendations for airway clearance therapies
Who is responsible for recommending, performing, and educating patients and families on airway clearance therapy (ACT)?
The interdisciplinary healthcare team
Study Notes
Effectiveness of Nonpharmacologic Airway Clearance Therapies
- Patient preference is an important consideration when selecting airway clearance therapy at home.
- The expected outcomes of airway clearance therapy should be clearly articulated, and therapy should be discontinued if the therapeutic goal is not achieved in the specified time.
- In the absence of high-level evidence, decisions regarding airway clearance therapy may be made based on clinical judgment.
- There is a lack of high-level evidence demonstrating benefit from many airway clearance techniques, despite clinical enthusiasm for them.
- Methodologically sound research is needed to improve the scientific basis for airway clearance techniques.
- Routine delivery of airway clearance techniques to non-cystic fibrosis hospitalized patients cannot be supported due to lack of evidence of significant benefit.
- There is a lack of high-level evidence supporting airway clearance techniques for neuromuscular disease patients, despite a large number of observational reports and guidelines.
- Cough assist techniques may be beneficial for patients with weak cough, based on low-level evidence from observational studies.
- Avoidance of pulmonary complications is the prudent approach post upper abdominal and thoracic surgery, and routine use of incentive spirometry cannot be supported.
- Time-honored therapies without sufficient evidence should be abandoned in favor of multi-faceted approaches that include patient education, collaborative care, and early ambulation.
- The use of airway clearance techniques in the setting of atelectasis without retained airway secretions does not appear to be effective, especially in the setting of upper abdominal and thoracic incisions.
- CPAP by face mask can alleviate hypoxemia due to low tidal volumes and airway obstruction, and may avoid reintubation, but there is no evidence to support routine use for the prevention of postoperative complications.
Effectiveness of Nonpharmacologic Airway Clearance Therapies
- Patient preference is an important consideration when selecting airway clearance therapy at home.
- The expected outcomes of airway clearance therapy should be clearly articulated, and therapy should be discontinued if the therapeutic goal is not achieved in the specified time.
- In the absence of high-level evidence, decisions regarding airway clearance therapy may be made based on clinical judgment.
- There is a lack of high-level evidence demonstrating benefit from many airway clearance techniques, despite clinical enthusiasm for them.
- Methodologically sound research is needed to improve the scientific basis for airway clearance techniques.
- Routine delivery of airway clearance techniques to non-cystic fibrosis hospitalized patients cannot be supported due to lack of evidence of significant benefit.
- There is a lack of high-level evidence supporting airway clearance techniques for neuromuscular disease patients, despite a large number of observational reports and guidelines.
- Cough assist techniques may be beneficial for patients with weak cough, based on low-level evidence from observational studies.
- Avoidance of pulmonary complications is the prudent approach post upper abdominal and thoracic surgery, and routine use of incentive spirometry cannot be supported.
- Time-honored therapies without sufficient evidence should be abandoned in favor of multi-faceted approaches that include patient education, collaborative care, and early ambulation.
- The use of airway clearance techniques in the setting of atelectasis without retained airway secretions does not appear to be effective, especially in the setting of upper abdominal and thoracic incisions.
- CPAP by face mask can alleviate hypoxemia due to low tidal volumes and airway obstruction, and may avoid reintubation, but there is no evidence to support routine use for the prevention of postoperative complications.
Test your knowledge on the effectiveness of nonpharmacologic airway clearance therapies with this quiz. Explore the evidence, patient preferences, and clinical considerations for selecting and discontinuing airway clearance techniques.
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