Physiotherapy ICU Management Algorithm

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Clinical Algorithm Overview

Pulmonary Function

Mobility

Delphi Study Results

Contact Details

Delphi Study Results

Phase 1: Summary of Comments

Group 2: Changes on CxR

Best practice recommendations

Excessive Secretions
Atelectasis
Ventilator Associated Pneumonia ( VAP)
Hyperinflation ( MHI or VHI)

Best practice recommendations

Hyperinflation ( MHI or VHI)

Recommendation 1: Indication for hyperinflation

Formulation of recommendation	Strength of recommendation	Quality of Evidence
AGREEMENT:5/7 DISAGREEMENT: 0/7 NO RESPONSE: 2/7	AGREEMENT:4/7 DISAGREEMENT: 0/7 NO RESPONSE: 3/7	AGREEMENT:4/7 DISAGREEMENT: 0/7 NO RESPONSE: 3/7

POSTED COMMENTS:

No Comments

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Recommendation 2: Equipment preference

Formulation of recommendation	Strength of recommendation	Quality of Evidence
AGREEMENT:3/7 DISAGREEMENT: 2/7 NO RESPONSE: 2/7	AGREEMENT:4/7 DISAGREEMENT: 0/7 NO RESPONSE: 3/7	AGREEMENT:4/7 DISAGREEMENT: 0/7 NO RESPONSE: 3/7

POSTED COMMENTS:

A PEEP level where disconnection should not occur (the literature would suggest 7.5-10cmH2O) should be set as a part of a unit protocol and a patient should not be disconnected from the ventilator at all despite the presence of a PEEP valve on a bagging circuit. If PEEP is an issue ventilator hyperinflation should be used. The risks of disconnection out weigh the fact there is no clinical disadvantage to using ventilator hyperinflation
I agree that VHI may be preferable is some situations only (not a routine preference). I agree that MHI should include a PEEP value, if PEEP>5, and set at same level as ventilator

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Recommendation 3: Choice of equipment for MHI

Formulation of recommendation	Strength of recommendation	Quality of Evidence
AGREEMENT:4/7 DISAGREEMENT: 0/7 NO RESPONSE: 3/7	AGREEMENT:4/7 DISAGREEMENT: 0/7 NO RESPONSE: 3/7	AGREEMENT:4/7 DISAGREEMENT: 0/7 NO RESPONSE: 3/7

POSTED COMMENTS:

No Comments

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ARDS specific recommendation

Recommendation from best practice management of ARDS

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ARDS specific recommendation 2:

New formulation based on feedback and reference

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