for intubation and invasive mechanical ventilation and possibly de- crease in-hospital mortality. Heliox: For now, it should not be part of the EB approach to treatment of acute COPD exacerbation. Let’s do our own analysis of Dr. Soto and Dr. Varkey’s EBM re-
view of this very important topic. Does this EBM review seem com- plete to you? Well, it doesn’t to me! Why? Well, it didn’t seem complete in many ways and categories. For instance, why didn’t they mention the use of EKG, sputum sampling and subsequent cul- ture and sensitivity or CBC in the “diagnostic testing” category? I don’t know. Maybe there’s no specific evidence there since no one has studied those categories. It’s a good question and worth inves- tigating more. The article by Soto and Varkey contained 67 refer- ences with commentary on how or why these references might be useful. Is it a useful article? In my opinion it is. Should it represent the last word on this topic? No, Is there more evidence or guidance on this topic? Yes. This site is the Veterans Health Administration Clinical Practice Guideline For The Management of COPD or Asthma-Inpatient Management of COPD: Emergency Department Management (Module B1) and is part of a series of modules pub- lished on the net which contain a wealth of information on COPD management and are designed to assist respiratory therapists, nurses, physicians and others in this segment of care. References to the literature, along with a “Table of Evidence” providing the spe- cific intervention, the article or articles that were used, the “grade of evidence” and “strength of evidence” (both quality indicators for the EB approach) are listed. This would be an excellent starting point for any respiratory therapy department wishing to “stop the madness” with regard to unnecessary, useless or even harmful respiratory therapy. Are you interested in seeing what the government has to say
about this topic? Go to:
http://www.ahcpr.gov/clinic/epcquick.htm to see what the Agency for Healthcare Research and Quality (AHRQ) has to offer in terms of this and other topics. Public Law 106-129 of 1999 law authorizes AHRQ (a part of the U.S. Dept. of Health and Human Services) to “continue its research on the cost, quality, and outcomes of health care and expands its role to improve patient safety and address medical errors”. This document, entitled Manage- ment of Acute Exacerbations of Chronic Obstructive Pulmonary Dis- ease may be used as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reim- bursement and coverage policies.
Conclusion The EB approach, EBM or whatever other labels are to come,
that use the literature as the basis for treating our patients in the best ways possible including therapeutically, economically, psychoso- cially, humanely, etc., is here to stay. As a respiratory therapist these many years, it is my observation that many of us (at least in my gen- eration, the tail end of the infamous “baby boomers”) entered the profession of Respiratory Therapy to help others and to make a true difference (along with making a decent living and making a great life). The EB approach to patient care is unquestionably the answer to the madness of diagnostics and therapeutics without scientific basis. Shouldn’t everyone (including the bean counters) be happy when we follow “what works and what doesn’t”? The EB approach within our profession is one of the major keys to our professional growth and development. We need to embrace it and use it to our advantage if we are to survive, develop and grow.
Nov/Dec 2010
Management and Clinical Expertise for Respiratory Care & Sleep Medicine
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July/Aug 2010 FOCUS JOURNAL Management and Clinical Expertise for Respiratory Care & Sleep Medicine
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