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

Development of clinically effective protocols for use in managing mechanical ventilation is a time-consuming process that requires allocation of substantial resources. Clear development of protocol goals, incorporation of the best available evidence, coordination of a multidisciplinary protocol development team, and extensive bedside testing and protocol refinement are essential steps in protocol development. Safe implementation of the protocol requires an effective, ongoing training program. Protocols that direct clinical care require careful monitoring to ensure compliance and to identify adverse events. Finally, protocols must be followed and updated when new evidence becomes available.