7.1 Evidenced-Based Medicine

According to an article written by Dean Hess, PhD, RRT, FAARC, FCCM, FCCP, evidence-based medicine (EBM) is the integration of individual clinical expertise with the best available evidence from systematic research and the patient’s values and expectations. The best evidence is extrapolated to the patient’s unique pathophysiology. EBM does not devalue clinical skills and clinical judgment. Rather, EBM demands a skilled clinician to inform its judicious application. The practice of EBM requires us to apply the evidence to the right patient, at the right time, in the right place, at the right dose, and using the right resources.

Clinical evidence comes from real clinical research among intact patients. Bench studies, simulations, animal studies, and other types of physiologic studies can support human studies. However, we should recognize that these are low-levels of evidence, and we need to be cautious about extrapolating these data to patient care. The best clinical evidence is not static, but changes when new and better evidence becomes available.

The practice of EBM does not discount patient values and expectations. For example, a compelling body of high-level clinical evidence supports the use of noninvasive ventilation (NIV) in patients with COPD exacerbation, yet some patients prefer not to receive NIV. As another example, clinician bias might suggest the use of a pressurized metered-dose inhaler (pMDI) rather than a nebulizer for delivery of an inhaled bronchodilator; however, evidence suggests that the two approaches yield similar outcomes. If a patient prefers to use a nebulizer rather than a pMDI, the patient’s choice should be respected^[1].