Pulmonary Medicine Practice Guidelines

This guideline addresses the appropriate selection of a device for the administration of aerosolized medications by small volume nebulizer (SVN), large volume nebulizer (LVN), metered dose inhaler (MDI), and dry powder inhaler (DPI) to neonatal and pediatric patients.
SOURCE: American Association for Respiratory Care Clinical Practice Guidelines, 1995

Delivery of therapeutic aerosols to the upper airway including the nose, pharynx, and larynx--therapeutic aerosols are indicated for upper airway inflammation, anesthesia, rhinitis, and administration of medications for systemic effect.
SOURCE: American Association for Respiratory Care Clinical Practice Guidelines, 1994

The selection of a device for administration of pharmacologically active aerosol to the lower airway. The device selected should produce particles with a mass median aerodynamic diameter (MMAD) of 2-5 microns.
SOURCE: American Association for Respiratory Care Clinical Practice Guidelines, 1992

American Academy of Pediatrics

This Executive Summary reviews key points about diagnosis and management of rhinitis contained in the comprehensive document, Diagnosis and Management of Rhinitis: Complete Guidelines of Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology, and Joint Task Force Algorithm and Annotations for Diagnosis and Management of Rhinitis. These documents represent a consensus opinion of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology, a national panel co-sponsored by the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council on Allergy, Asthma and Immunology.
SOURCE: Joint Council on Allergy, Asthma and Immunology, 1998

Cough can (a) be an important defense mechanism to help clear excessive secretions and foreign material from airways; (b) be an important factor in the spread of infection; (c)maintain consciousness during potentially lethal arrhythmias and/or convert arrhythmias to more normal cardiac rhythms; and (d) present as one of the most common symptoms for which patients seek medical attention and spend health-care dollars.
SOURCE: American College of Chest Physicians Consensus Statement, 1998

This position statement informs physicians and patients with asthma about the importance of environmental allergen avoidance in the treatment of allergic asthma.
SOURCE: Ad Hoc Working Group on Environmental Allergens and Asthma, from the American Academy of Allergy, Asthma and Immunology (J Clin Immunol 103:203-205, February 1999)

This guide presents basic recommendations for the diagnosis and management of asthma that will help clinicians and patients make appropriate decisions about asthma care.
SOURCE: National Heart, Lung, and Blood Institute, 1998

Based on a March 1993 Meeting

Adapted in part from the National Asthma Education Program 2 Guidelines, American Thoracic Society, 1998

The new longer-acting inhaled Beta-agonist, salmeterol, has been approved for use in the United States since the last Committee on Drugs/AAAAI position statement on Beta-agonists was published. Since its approval, reports of sudden severe attacks of asthma or of patients found dead holding their salmeterol inhaler have raised concerns that in certain patients under certain conditions salmeterol might cause sudden worsening of asthma and even death. The purposes of this statement are to take a position on the perceived dangers of this new pharmacologic agent for asthma and make suggestions or its proper use.
SOURCE: Committee on Drugs, American Academy of Allergy, Asthma and Immunology, 1996

Assessing response in adults and older children to aerosolized bronchodilator therapy at the point of care. Although subjective responses and changes in mucociliary activity are important bronchodilator therapy effects, this guideline emphasizes the airway smooth muscle response that is primarily quantified through measurement of pulmonary function. It does not address initial diagnostic or ongoing (longitudinal) laboratory evaluation.
SOURCE: American Association for Respiratory Care Clinical Practice Guidelines, 1995

The U.S. Food and Drug Administration (FDA) has requested that all manufacturers of oral, injectable, and inhaled corticosteroids make labeling changes. These changes warn physicians that treatment with corticosteroids may place patients who have varicella or other viral infections at an increased risk of complications, including death.
SOURCE: Executive Committee of the American Academy of Allergy, Asthma and Immunology, 1993

In 1985 the Committee on Drugs of the American Academy of Allergy, Asthma and Immunology published a position statement entitled Adverse Effects and Complications of Treatment with Beta-Adrenergic Agonist Drugs.: The issues discussed in this statement included the possible role of Beta-agonists in increasing airway obstruction, aggravating hypoxemia, and causing adverse effect and increased deaths in asthma.
SOURCE: Executive Committee of the American Academy of Allergy, Asthma and Immunology, 1993

Although the number of chronic VAIs in acute care hospitals is small relative to the total number of patients receiving mechanical ventilation, VAIs consume a disproportionate share of health-care expenditures and occupy ICU beds for prolonged periods. VAIs, therefore, pose a unique set of questions for the health-care team.
SOURCE: American College of Chest Physicians Consensus Statement, 1998

The purpose of this consensus report was to address clinically relevant questions related to the diagnosis and management of acute pulmonary embolism and deep venous thrombosis.
SOURCE: American College of Chest Physicians Consensus Statement, 1998

The selection of an oxygen delivery system for neonatal and pediatric patients includes patients with and without artificial airways.
SOURCE: American Association for Respiratory Care Clinical Practice Guidelines, 1996

Recognition of signs of an impending or actual airway emergency. Initial treatment and continued management of airway emergencies to minimize the likelihood of adverse outcomes, in adults, children, and infants.
SOURCE: American Association for Respiratory Care Clinical Practice Guidelines, 1995

Capillary blood gas (CBG) samples may be used in place of samples from arterial punctures or indwelling arterial catheters to estimate acid-base balance (pH) and adequacy of ventilation (PaCO2). Capillary PO2 measurements are of little value in estimating arterial oxygenation.
SOURCE: American Association for Respiratory Care Clinical Practice Guidelines, 1994

Transcutaneous monitoring of oxygen (PtcO2) and carbon dioxide (PtcCO2) in neonates, infants, and small children -- this guideline does not address the application of transcutaneous monitoring in adults and older children.
SOURCE: American Association for Respiratory Care Clinical Practice Guidelines, 1994

The application of time-triggered, pressure-limited, time-cycled mechanical ventilation in the neonate is typically accomplished by the use of commercially available pressure-limited ventilators specifically designed for this population or of multipurpose, multimodal ventilators with the necessary capabilities. These ventilators permit precise management of ventilator settings.
SOURCE: American Association for Respiratory Care Clinical Practice Guidelines, 1994

The application of continuous positive airway pressure to neonates and infants by nasal prongs (NCPAP) or by nasopharyngeal tube (NP-CPAP) used in conjunction with a commercially available continuous-flow infant ventilator or a suitably equipped multipurpose ventilator.
SOURCE: American Association for Respiratory Care Clinical Practice Guidelines, 1994

Directed cough (DC) to clear or mobilize secretions is a component of bronchial hygiene therapy when spontaneous cough is inadequate. Directed Cough is a deliberate maneuver that is taught, supervised, and monitored. Forced expiratory technique (FET, or huff cough) and manually assisted cough are examples of directed cough.
SOURCE: American Association for Respiratory Care Clinical Practice Guidelines, 1993

Genetic testing is available for a variety of diseases and will soon be available for many more. Furthermore, genetic predispositions to common diseases are becoming known and potentially will affect large segments of the population. This consensus conference considered cystic fibrosis (CF), a well-characterized, serious genetic disease for which testing is becoming available, and a series of recommendations for genetic testing in the population is presented.
SOURCE: National Institutes of Health Consensus Development Conference Statement, 1997

SOURCE: Centers for Disease Control and Prevention, June 09, 2000 / 49(RR06);1-54

These recommendations update information concerning the vaccine and antiviral agents available for controlling influenza during the 2000-2001 influenza season.
SOURCE: Advisory Committee on Immunization Practices, 2000

This report contains updated information regarding a) antimicrobial resistance among pneumococci, b) vaccine effectiveness and cost-effectiveness, c) indications for vaccination, d) guidelines for revaccination, e) strategies for improving delivery of vaccine, and f) development of pneumococcal conjugate vaccine.
SOURCE: Advisory Committee on Immunization Practices, 1996

This document updates and replaces CDC's previously published 'Guideline for Prevention of Nosocomial Pneumonia.'
SOURCE: National Center for Infectious Diseases and the Hospital Infection Control Practices Advisory Committee, 1994

CDC recommendations on the use of PCP prophylaxis in children born to HIV-infected women.
SOURCE: Working Group on PCP Prophylaxis for Children, 1995

A pathogenic role for IgE-dependent reactions in allergic diseases has been established. Evidence for IgE antibodies, however, is lacking in many cases of chronic asthma, rhinitis, and urticaria. Some investigators have also attributed to one of the subclasses of IgG, namely IgG4, the activity of an effector or anaphylactic antibody.
SOURCE: Executive Committee of the American Academy of Allergy, Asthma and Immunology, 1995

The objective of this conference was to review and analyze the risk of TB transmission in health-care facilities today, and the means available for protecting workers, patients, and visitors from the perspective of clinicians who have worked closely with the disease over the years.
SOURCE: American College of Chest Physicians Consensus Statement, 1995

The U.S. Food and Drug Administration (FDA) has requested that all manufacturers of oral, injectable, and inhaled corticosteroids make labeling changes. These changes warn physicians that treatment with corticosteroids may place patients who have varicella or other viral infections at an increased risk of complications, including death.
SOURCE: Executive Committee of the American Academy of Allergy, Asthma and Immunology, 1993

The selection of an oxygen delivery system for neonatal and pediatric patients includes patients with and without artificial airways.
SOURCE: American Association for Respiratory Care Clinical Practice Guidelines, 1996

CDC recommendations on the use of PCP prophylaxis in children born to HIV-infected women.
SOURCE: Working Group on PCP Prophylaxis for Children, 1995

Infant/toddler pulmonary function tests measure a variety of pulmonary variables in subjects who are generally too young to perform, comprehend, or comply with necessary instructions for conventional pulmonary diagnostic procedures (eg, forced vital capacity, slow vital capacity, panting airways mechanics).
SOURCE: American Association for Respiratory Care Clinical Practice Guidelines, 1995

This guideline addresses the appropriate selection of a device for the administration of aerosolized medications by small volume nebulizer (SVN), large volume nebulizer (LVN), metered dose inhaler (MDI), and dry powder inhaler (DPI) to neonatal and pediatric patients.
SOURCE: American Association for Respiratory Care Clinical Practice Guidelines, 1995

Capillary blood gas (CBG) samples may be used in place of samples from arterial punctures or indwelling arterial catheters to estimate acid-base balance (pH) and adequacy of ventilation (PaCO2). Capillary PO2 measurements are of little value in estimating arterial oxygenation.
SOURCE: American Association for Respiratory Care Clinical Practice Guidelines, 1994

Transcutaneous monitoring of oxygen (PtcO2) and carbon dioxide (PtcCO2) in neonates, infants, and small children -- this guideline does not address the application of transcutaneous monitoring in adults and older children.
SOURCE: American Association for Respiratory Care Clinical Practice Guidelines, 1994

The application of time-triggered, pressure-limited, time-cycled mechanical ventilation in the neonate is typically accomplished by the use of commercially available pressure-limited ventilators specifically designed for this population or of multipurpose, multimodal ventilators with the necessary capabilities. These ventilators permit precise management of ventilator settings.
SOURCE: American Association for Respiratory Care Clinical Practice Guidelines, 1994

The application of continuous positive airway pressure to neonates and infants by nasal prongs (NCPAP) or by nasopharyngeal tube (NP-CPAP) used in conjunction with a commercially available continuous-flow infant ventilator or a suitably equipped multipurpose ventilator.
SOURCE: American Association for Respiratory Care Clinical Practice Guidelines, 1994

In the United States, the overall prevalence of COPD in adult white populations is 4 to 6% in men and 1 to 3% in women. In persons older than 55 years, COPD is recognized in approximately 10 to 15%., As of 1985, the prevalence rates of COPD in adults 65 years and older was 167/1,000 in men and 126/1,000 in women. Recent trends suggest that disease prevalence is stable to decreasing in men, but increasing among women. The 1993 National Health Interview Survey estimated that 14 million adults had chronic bronchitis and 2 million had emphysema.
SOURCE: Joint American College of Chest Physicians/American Association of Cardiovascular and Pulmonary Rehabilitation Evidence-Based Guidelines, 1996

Nutrition support is a routine part of ICU therapy. It is recommended to treat and prevent malnutrition and nutrient deficiencies and generally benefits patient outcomes, although adverse effects and complications of the therapy do occur. Because a large number of clinical studies of applied nutrition have been performed in ICU patients, a consensus panel was commissioned to summarize current knowledge and formulate recommendations.
SOURCE: American College of Chest Physicians Consensus Statement, 1997

Development and implementation of a comprehensive plan for the safe discharge of the respiratory care patient from a health care facility and for continuing safe and effective care at an alternate site.
SOURCE: American Association for Respiratory Care Clinical Practice Guidelines, 1995

We developed a short-length document that clearly delineates a prudent approach to and criteria for reimbursement of positive airway pressure (PAP) costs for the treatment of obstructive sleep apnea (OSA).
SOURCE: CHEST: The Cardiopulmonary and Critical Care Journal, 1999