Critical Care Clinical Practice Guidelines: Understanding 2015 & Key Resources

Clinical practice guidelines are essential tools in healthcare, offering evidence-based recommendations to enhance patient care and standardize practices. For professionals in critical care, these guidelines are particularly crucial, informing everything from ventilator management to airway clearance therapies. While the landscape of medical guidelines is constantly evolving, understanding the historical context, such as the guidelines available around 2015, remains valuable for a comprehensive perspective.

This article serves as an enhanced guide to clinical practice guidelines relevant to critical care, drawing from resources like the American Association for Respiratory Care (AARC) and other leading organizations. Although this article does not directly focus on coding guidelines, it’s important to recognize that clinical practice guidelines indirectly influence coding by establishing standards of care that are reflected in medical billing and documentation. Understanding these clinical guidelines can provide a foundational understanding that indirectly supports accurate coding practices in critical care settings.

This resource compiles various categories of clinical practice guidelines, ensuring you have a robust starting point for your research and practice.

Evidence-Based Clinical Practice Guidelines

Evidence-based guidelines are developed through a rigorous process of systematically reviewing and evaluating the best available research evidence. These guidelines offer strong recommendations based on scientific findings, designed to optimize patient outcomes.

AARC Clinical Practice Guideline: Patient-Ventilator Assessment (2024) This guideline provides the latest recommendations for assessing patients who are mechanically ventilated, ensuring optimal ventilator support and patient safety.
AARC Clinical Practice Guideline: Spontaneous Breathing Trials for Liberation From Adult Mechanical Ventilation (2024) Focused on the critical process of weaning patients from mechanical ventilation, this 2024 guideline details best practices for spontaneous breathing trials.
AARC Clinical Practice Guidelines: Capillary Blood Gas Sampling for Neonatal and Pediatric Patients (2022) Addressing the specific needs of neonatal and pediatric patients, this guideline covers the proper techniques for capillary blood gas sampling, vital for accurate respiratory assessment in these vulnerable populations.
AARC Clinical Practice Guidelines: Artificial Airway Suctioning (2022) Effective suctioning of artificial airways is paramount to prevent complications. This 2022 guideline provides evidence-based recommendations for this critical procedure.
AARC Clinical Practice Guideline: Management of Adult Patients With Oxygen in the Acute Care Setting (2022) Oxygen therapy management in acute care settings requires careful consideration. This guideline focuses on the optimal management of oxygen for adult patients.
AARC Clinical Practice Guideline: Management of Pediatric Patients with Oxygen in the Acute Care Setting (2021) Complementing the adult guideline, this resource specifically addresses the nuances of oxygen management for pediatric patients in acute care.
AARC Clinical Practice Guideline: Management of Adult Patients with Tracheostomy in the Acute Care Setting (2021) Tracheostomy care in acute settings presents unique challenges. This guideline offers direction for managing adult patients with tracheostomies.
AARC Clinical Practice Guideline: Management of Pediatric Patients with Tracheostomy in the Acute Care Setting (2021) Similar to the adult tracheostomy guideline, this resource is tailored to the specific needs of pediatric patients with tracheostomies in acute care.
AARC Clinical Practice Guideline: Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients (2015) This 2015 guideline is particularly relevant to the context of “Critical Care Coding Guidelines 2015”. It focuses on the effectiveness of pharmacologic interventions for airway clearance in hospitalized patients, a key aspect of respiratory care that impacts coding and billing related to respiratory treatments.
AARC Clinical Practice Guideline: Effectiveness of Nonpharmacologic Airway Clearance Therapies in Hospitalized Patients (2013) Complementing the pharmacologic guideline, this 2013 document addresses non-pharmacologic methods for airway clearance, providing a comprehensive view of airway management strategies.
Evidence-based clinical practice guideline: Inhaled nitric oxide for neonates with acute hypoxic respiratory failure (2010) Inhaled nitric oxide is a critical therapy for neonates with hypoxic respiratory failure. This guideline from 2010 outlines its evidence-based application.
Care of the ventilator circuit and its relation to ventilator associated pneumonia (2003) Ventilator-associated pneumonia (VAP) is a significant concern in critical care. This 2003 guideline addresses ventilator circuit care as a strategy to reduce VAP risk.
Weaning and discontinuing ventilatory support (2002) This 2002 guideline provides foundational principles for weaning patients from ventilatory support, a crucial step in patient recovery and discharge.

Expert Panel Reference-Based Guidelines

Expert panel reference-based guidelines are developed by panels of experts who synthesize available evidence and clinical experience to provide recommendations. While not always based on systematic reviews of randomized controlled trials, these guidelines represent expert consensus and best practices in the field.

Aerosol delivery device selection for spontaneously breathing patients (2012) Selecting the appropriate aerosol delivery device is crucial for effective respiratory therapy. This 2012 guideline offers expert recommendations for spontaneously breathing patients.
Application of continuous positive airway pressure to neonates via nasal prongs, or nasopharyngeal tube, or nasal mask (2004) CPAP application in neonates requires specialized techniques. This 2004 guideline details methods for CPAP delivery via different interfaces.
Blood gas analysis and hemoximetry (2013) Accurate blood gas analysis is fundamental in critical care. This 2013 guideline covers best practices for blood gas assessment and hemoximetry.
Bronchoscopy assisting (2007) Bronchoscopy is a complex procedure requiring skilled assistance. This 2007 guideline outlines the role and responsibilities of bronchoscopy assistants.
Capillary blood gas sampling for neonatal and pediatric patients (2001) An earlier guideline on capillary blood gas sampling in neonates and pediatrics, providing historical context to the 2022 evidence-based guideline.
Capnography/capnometry during mechanical ventilation (2011) Capnography and capnometry are valuable monitoring tools during mechanical ventilation. This 2011 guideline addresses their application.
Effect of race and ethnicity on pulmonary function testing interpretation (2023) Recognizing the impact of demographic factors, this 2023 guideline addresses the influence of race and ethnicity on pulmonary function test interpretation.
Endotracheal suctioning of mechanically ventilated patients with artificial airways (2010) Endotracheal suctioning is a routine yet critical procedure. This 2010 guideline provides expert recommendations for mechanically ventilated patients.
Humidification during invasive and non invasive mechanical ventilation (2012) Proper humidification is essential during mechanical ventilation. This 2012 guideline covers humidification practices for both invasive and non-invasive ventilation.
In-hospital transport of the mechanically ventilated patient (2002) Transporting mechanically ventilated patients within the hospital requires careful planning and execution. This 2002 guideline addresses safety and best practices for intra-hospital transport.
Incentive spirometry (2011) Incentive spirometry is a common technique for respiratory rehabilitation. This 2011 guideline covers its appropriate application.
Infant/toddler pulmonary function tests (2008) Pulmonary function testing in infants and toddlers requires specialized approaches. This 2008 guideline addresses these unique considerations.
Intermittent positive pressure breathing (2003) Intermittent positive pressure breathing (IPPB) has a role in certain respiratory therapies. This 2003 guideline discusses its application.
Long-term invasive mechanical ventilation in the home (2007) Home mechanical ventilation requires specific protocols and considerations. This 2007 guideline addresses long-term invasive ventilation in the home setting.
Metabolic measurement using indirect calorimetry during mechanical ventilation (2004) Indirect calorimetry can optimize nutritional support for mechanically ventilated patients. This 2004 guideline covers metabolic measurement techniques.
Nasotracheal suctioning (2004) Nasotracheal suctioning is another airway clearance technique. This 2004 guideline provides guidance on its performance.
Oxygen therapy for adults in the acute care facility (2002) An earlier guideline on oxygen therapy for adults, offering a historical perspective alongside the more recent 2022 evidence-based guideline.
Oxygen therapy in the home or alternate site health care facility (2007) Oxygen therapy extends beyond the acute care setting. This 2007 guideline covers oxygen management in home and alternate healthcare facilities.
Polysomnography (1995) Polysomnography is the gold standard for sleep disorder diagnosis. This 1995 guideline provides a historical reference for sleep study procedures.
Providing patient and caregiver training (2010) Patient and caregiver education is integral to successful respiratory care. This 2010 guideline emphasizes the importance of training.
Removal of the endotracheal tube (2007) Extubation, or endotracheal tube removal, requires careful management. This 2007 guideline addresses the process of safe and effective extubation.
Surfactant replacement therapy (2013) Surfactant replacement therapy is critical for neonates with respiratory distress syndrome. This 2013 guideline outlines its use.
Transcutaneous blood gas monitoring for neonatal and pediatric patients (2012) Transcutaneous blood gas monitoring offers a non-invasive method for assessing oxygenation and ventilation in neonates and pediatrics. This 2012 guideline discusses its application.

AARC-Retired Guidelines

Retired guidelines are those that have been superseded by newer recommendations or are no longer considered current best practice. However, they can still be valuable for historical context and understanding the evolution of clinical practice.

Assessing response to bronchodilator therapy at point of care (1995) A retired guideline on assessing bronchodilator response, offering a historical view on point-of-care assessments.
Bland aerosol administration (2003) A retired guideline on bland aerosol administration, reflecting past practices in aerosol therapy.
Body plethysmography (2001) A retired guideline for body plethysmography, providing historical context for lung volume measurement techniques.
Defibrillation during resuscitation (1995) A retired guideline on defibrillation during resuscitation, reflecting earlier protocols in emergency cardiac care.
Directed cough (1993) A retired guideline on directed cough techniques, representing past approaches to airway clearance.
Discharge planning for the respiratory care patient (1995) A retired guideline for discharge planning, showcasing the evolution of care transitions for respiratory patients.
Exercise testing for evaluation of hypoxemia and/or desaturation (2001) A retired guideline on exercise testing, reflecting past methods for evaluating hypoxemia and desaturation.
Management of airway emergencies (1995) A retired guideline on airway emergency management, providing a historical perspective on critical airway interventions.
Methacholine challenge testing (2001) A retired guideline for methacholine challenge testing, illustrating the historical approach to bronchial provocation testing.
Neonatal time-triggered, pressure-limited, time-cycle mechanical ventilation (1994) A retired guideline on a specific mode of neonatal ventilation, showcasing the evolution of ventilation strategies for newborns.
Patient-ventilator system checks (1992) A retired guideline for patient-ventilator system checks, reflecting past protocols for ventilator monitoring and maintenance.
Postural drainage therapy (1991) A retired guideline on postural drainage therapy, representing older approaches to airway clearance.
Pulmonary rehabilitation (2002) A retired guideline on pulmonary rehabilitation, providing a historical view of rehabilitation practices.
Pulse oximetry (1992) A retired guideline for pulse oximetry, offering historical context for oxygen saturation monitoring.
Resuscitation and defibrillation in the health care setting (2004) A retired guideline on resuscitation and defibrillation, reflecting past protocols in emergency care settings.
Sampling for arterial blood gas analysis (1992) A retired guideline on arterial blood gas sampling, providing historical context for invasive blood gas assessment.
Selection of a device for delivery of aerosol to the lung parenchyma (1996) A retired guideline on aerosol device selection, reflecting past approaches to targeted aerosol delivery.
Selection of an aerosol device for neonatal and pediatric patients (1995) A retired guideline on aerosol device selection for younger patients, showcasing historical practices in pediatric aerosol therapy.
Selection of an oxygen delivery device for neonatal and pediatric patients (2002) A retired guideline on oxygen delivery device selection for neonates and pediatrics, providing historical context for oxygen therapy in young patients.
Selection of device, administration of bronchodilator, and evaluation of response to therapy in mechanically ventilated patients (1999) A retired guideline on bronchodilator therapy in mechanically ventilated patients, reflecting past approaches to bronchodilation in this population.
Single-breath carbon monoxide diffusing capacity (1999) A retired guideline for single-breath carbon monoxide diffusing capacity testing, offering historical context for DLCO measurement.
Spirometry (1996) A retired guideline on spirometry, providing historical context for this fundamental lung function test.
Static lung volumes (2001) A retired guideline for static lung volume measurement, reflecting past techniques for assessing lung volumes.
Suctioning of the patient in the home (1999) A retired guideline on suctioning in the home setting, showcasing historical practices for home respiratory care.
Training the health care professional for the role of patient and caregiver education (1996) A retired guideline on training healthcare professionals for patient education, highlighting the long-standing emphasis on patient and caregiver training.
Use of positive airway pressure adjuncts to bronchial hygiene therapy (1993) A retired guideline on positive airway pressure adjuncts for bronchial hygiene, reflecting past approaches to airway clearance therapies.

Guidelines From Other Organizations

Beyond the AARC, numerous other organizations contribute significantly to clinical practice guidelines relevant to critical care. These guidelines often provide a multi-disciplinary perspective and address a broad spectrum of critical care topics.

Aerosol Therapy

ACCP Device Selection and Outcomes of Aerosol Therapy: Evidence-Based Guidelines (2005) From the American College of Chest Physicians (ACCP), this guideline focuses on aerosol therapy device selection and its impact on patient outcomes.

Airway Management

ASA Practice Guidelines for the Management of the Difficult Airway (2013) The American Society of Anesthesiologists (ASA) provides these guidelines for managing difficult airways, a critical skill in critical care and emergency medicine.

ARDS

ATS/ESICM/SCCM Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome A collaborative guideline from the American Thoracic Society (ATS), the European Society of Intensive Care Medicine (ESICM), and the Society of Critical Care Medicine (SCCM), focusing on mechanical ventilation strategies for ARDS.

Asthma

NAEPP EPR-3 2007 Asthma Guidelines The National Asthma Education and Prevention Program (NAEPP) provides these comprehensive asthma guidelines, relevant to managing asthma exacerbations in critical care.

Bronchiolitis

AAP Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis (2014) The American Academy of Pediatrics (AAP) offers this guideline on bronchiolitis, a common respiratory illness in infants that may require critical care.

Childhood Interstitial Lung Disease in Infancy

ATS CPG: Classification, Evaluation, and Management of Childhood Interstitial Lung Disease (chILD) in Infancy (2013) The ATS provides guidelines for the complex area of childhood interstitial lung disease, important for pediatric critical care.

Cystic Fibrosis

CFF: Cystic Fibrosis Pulmonary Guidelines: Airway Clearance Therapies (2009) The Cystic Fibrosis Foundation (CFF) offers these guidelines on airway clearance therapies for patients with cystic fibrosis, relevant in managing CF-related respiratory complications in critical care.

Emergency Cardiovascular Care

AHA ECC 2015 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care The American Heart Association (AHA) 2015 guidelines for CPR and ECC are highly significant in the context of “critical care coding guidelines 2015”. These guidelines, updated in 2015, directly impact coding and billing related to emergency cardiovascular care and resuscitation procedures performed in critical care settings. The 2015 update is a landmark revision that influenced coding practices significantly from that year onward.

End-of-Life Care

Recommendations for end-of-life care in the intensive care unit: A consensus statement by the American College of Critical Care Medicine (2008) The American College of Critical Care Medicine (ACCM) provides recommendations for end-of-life care in the ICU, addressing a sensitive but crucial aspect of critical care practice.

Home Mechanical Ventilation

ATS: An Official American Thoracic Society Clinical Practice Guideline: Pediatric Chronic Home Invasive Ventilation (2016) The ATS provides guidelines for pediatric chronic home invasive ventilation, addressing the unique needs of children requiring long-term ventilation at home.

ICU-Aqcuired Weakness in Adults

ATS Guideline: The Diagnosis of Intensive Care Unit-acquired Weakness in Adults (2014) ICU-acquired weakness is a significant complication of critical illness. This ATS guideline addresses its diagnosis in adult patients.

Non-Invasive Positive Pressure Ventilation

AHRQ Comparative Effectiveness Report Number 68: Noninvasive Positive-Pressure Ventilation (NPPV) for Acute Respiratory Failure (2012) The Agency for Healthcare Research and Quality (AHRQ) provides this comparative effectiveness report on non-invasive positive pressure ventilation for acute respiratory failure.

Obstructive Sleep Apnea

AASM Clinical Guideline for the Evaluation, Management, and Long-Term Care of Obstructive Sleep Apnea in Adults (2009) The American Academy of Sleep Medicine (AASM) offers guidelines for obstructive sleep apnea, relevant to managing OSA patients who may require critical care.

Palliative Care

NCP Clinical Practice Guidelines for Quality Palliative Care, 4th edition (2018) The National Coalition for Hospice and Palliative Care (NCP) provides guidelines for palliative care, an increasingly integrated aspect of critical care.

Respiratory Illness: Diagnosis and Treatment

Diagnosis and treatment of respiratory illness in children and adults (2013) Guidelines for the diagnosis and treatment of respiratory illnesses in both children and adults.

Smoking Cessation

Smoking Cessation Guidelines from the Surgeon General Comprehensive smoking cessation guidelines from the Surgeon General, crucial for preventing respiratory disease and improving outcomes.

Transport of Critically Ill Patients

SCCM Guidelines for the Inter- and Intrahospital Transport of Critically Ill Patients (2004) SCCM guidelines for the safe transport of critically ill patients within and between hospitals.

Ventilator Associated Pneumonia/Ventilator Associated Events

Centers for Disease Control Device-Associated module: Ventilator Associated Event Protocol (2013) CDC protocols for ventilator-associated events, focusing on prevention and surveillance.
Institute for Clinical Systems Improvement: Prevention of Ventilator Associated Pneumonia (2011) Guidelines from the Institute for Clinical Systems Improvement on preventing ventilator-associated pneumonia.

Wheezing in Infants

ATS CPG: Diagnostic Evaluation of Infants with Recurrent or Persistent Wheezing ATS guidelines for the diagnostic evaluation of recurrent or persistent wheezing in infants.

By utilizing this comprehensive compilation of clinical practice guidelines, healthcare professionals can stay informed about the best practices in critical care, ultimately leading to improved patient outcomes. Remember to always refer to the most current versions of guidelines and consider the specific context of your clinical setting when applying these recommendations.