A practical approach to evidence-based medicine: lessons learned from developing ventilator management protocols

Development of robust clinical protocols is a time-consuming process that requires allocation of sufficient time and resources. As outlined for the mechanical-ventilation protocol, the goals of the protocol must be clear before embarking on this journey. Critical appraisal of existing evidence is an essential first step to developing a draft protocol. The inclusion of a multidisciplinary team of clinicians, including nurses and respiratory therapists, is required to refine the logic and to ensure protocol acceptance. Extensive bedside testing of the protocol across the spectrum of patients in which it will be applied is essential for ensuring that the protocol works as intended. An effective, ongoing training program must be implemented to ensure protocol success. The final protocol should be carefully monitored in 50 to 100 patients to ensure that clinicians are complying with the protocol rules and that adverse events related to the protocol are not occurring. Finally, protocols must be tended to and updated when new evidence becomes available.