Home
Clinical Algorithm Overview
Pulmonary Function
Mobility
Delphi Study Results
Contact Details
 
 
 
 
 
 
 
 
 
 
 
 
 
Delphi Study Results
 

Phase 1: Results: Summary of Comments

Group 5: ARDS/ALI

  • Clinical algorithm for the management of intubated patients presenting with ALI or ARDS

Clinical algorithm for the management of intubated patients presenting with ALI or ARDS

SUBJECT 1: Comments on the criteria used to identify patients with ARDS/ALI

AGREEMENT: 2/5
DISAGREEMENT:2 /5
No Response: 1/5

POSTED COMMENTS:

  • The parameters do not indicate whether the patient has ALI or ASRDS and should do, as for ALI proning would not be indicated. Bilateral changes is too non-specific should state 'infiltrates'. Pulmonary artery catheters are not used much anymore - would it be better to state 'exclude pulmonary oedema
 

SUBJECT 2: Comments on contra indications for prone positioning

AGREEMENT: 2/5
DISAGREEMENT: 2/5
No Response: 1/5

POSTED COMMENTS:

  • There are a number onmitted which I have included in my 2001 publication which I think should be included here.
 

SUBJECT 3: Comments on the practical considerations before the implementation of the proning procedure.

AGREEMENT: 1/5
DISAGREEMENT: 3/5
No Response: 1/5

POSTED COMMENTS:

  • You need the staff to be competent in proning and care of the proned patient as well - the risk for injury, accidental lie removal and accidental extubation require more than just sufficient staff and extends beyond the action of proning. Consider te need to specify the presence of the attendng doctor - he/she should take responsibilty for the patient's airway.

  • What is an appropriate pressure relieving surface? i.e. be more specific

  • What is adequate sedation and muscle relaxation - should be more specific. If the aptient is so sick would n't you need more than a pulse oximeter, what is a sufficient number of staff to turn the aptient, again be more specific

 

SUBJECT 4: Comments on the preparations made before proning the patient

AGREEMENT: 1/5
DISAGREEMENT: 3/5
No Response: 1/5

POSTED COMMENTS:

  • Sliding sheets are not readily available in many of the units (both state and private in SA). with disconnection of the patient from cardiac monitoring, the patient must immediately be placed onto an alternate form of monitoring that can stay in place for the intervention - saturation monitor with finger probe will provide both oygen and heart rate data, or ensure that the arterial line is providing accurate data re heart rate

  • How long before shoulld the feed be stopped? What is appropriate lubrication for the eyes? Also, consider mouth care,check PERLA, ? Wound dressings complete, trcacheostomy dressiu

 

SUBJECT 5: Comments on the the proning of the patient

AGREEMENT: 2/5
DISAGREEMENT: 2/5
No Response: 1/5

POSTED COMMENTS:

  • If you don't have a sliding sheet, the method described here is going to be difficult to do. In my experience, curtains closed for privacy - the patient is moved to the side of the bed (NB at least 3 people needed on the patient side of the bed - head & neck, chest, pelvis and legs) , pillows placed on the mattress and in line with the patient's chest, pelvis and knees, doctor checks airway and vital IV lines, patient is rolled slowly prone onto the pillows with at least 3 people on the other side of the bed - doctor taking care of airway & lines.
 

SUBJECT 6: Comments on possible adverse reactions to turning prone

AGREEMENT: 3/5
DISAGREEMENT: 1/5
No Response: 1/5

POSTED COMMENTS:

  • No Comments
 

SUBJECT 7: Comments on positioning of the patient in prone

AGREEMENT: 1/5
DISAGREEMENT: 3/5
No Response: 1/5

POSTED COMMENTS:

  • Reverse trendellenberg only if patient can tolerate this haemodynamically. consider forehead, ear, nose tip, cheek or chin support and protection depending on how head is positioned - pressure sores happen very quickly with proned patients.

  • ?? Consideration of breasts and genitalia, shouldmalso include pasive movement of aptient - how often
 

SUBJECT 8: Comments on the identification and management of non-responders

AGREEMENT: 3/5
DISAGREEMENT: 1/5
No Response: 1/5

POSTED COMMENTS:

  • Wheres is that on the algorythm?
 

SUBJECT 9: Comments on the duration of the prone position in responders

AGREEMENT: 2/5
DISAGREEMENT: 2/5
No Response: 1/5

POSTED COMMENTS:

  • Insufficient information concerning on-going maangement of patient to avoid complications, also insufficient information concerning monitoring the effectiveness of the position.
 

SUBJECT 10: Comments on the indication for suction in ARDS patients and the inclusion of VHI procedure

AGREEMENT: 2/5
DISAGREEMENT: 2/5
No Response: 1/5

POSTED COMMENTS:

  • Also consider increasing airway pressure and desaturation as indication for suctioning - the potential complications of recruitment require a careful assessment of the actual necessity of the maneuver and its benefit to a specific patient, in addition to the consideration of contra-indications, prior to its implementation
  • What if another type of ventilator is used? Would it always be the CPAP function?
 

 
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
 
Copyright © 2008, All rights reserved, Design by Ck