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

Ventilator Associated Pneumonia (VAP)

Preventative Strategies: CPT

Formulation of strategy	Motivation
AGREEMENT:5/7 DISAGREEMENT: 0/7 NO RESPONSE: 2/7	AGREEMENT:5/7 DISAGREEMENT: 0/7 NO RESPONSE: 2/7

POSTED COMMENTS:

No Comments

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Recommendation 1: Patient positioning

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

POSTED COMMENTS:

No Comments

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Recommendation 2: Choice of suction system

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

POSTED COMMENTS:

No Comments

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Recommendation 3: CPT management of VAP

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

POSTED COMMENTS:

This package should only be institued if the patient has excessive pulmonary secretions and/or evidence of volume loss on CXR
Infiltrates do not necessarily imply secretions or atelectasis with mucus plugging. Cardiac pathology, fluid imbalances and ventilator (PEEP) settings can all influence the appearance of infiltrates on CXR. In addition, CXR interpretation has poor inter- and intra-rater reliability and I do not think that management decisions can be based on this investigation.

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