Clinical Algorithm Overview

Pulmonary Function


Delphi Study Results

Contact Details


This website was developed as a place to reach international consensus amongst clinicians; academics/researchers; and members of the interdisciplinary team involved in ICU patient management (nurses; intensivists) on a best practice physiotherapy clinical algorithm.

NOTE: The author had access to the clinical guidelines developed by the European respiratory Society of Intensive Care Medicine task force which was recently published (Gosselink et al 2008). These recommendations were incorporated into the algorithm where applicable.


The way forward

  • These results will be collated into management algorithms using the following key words based on the consensus median rating

    • DO Rating 1
    • SHOULD DO Rating 2
    • CONSIDER Rating 3
    • UNIMPORTANT Rating 4
    • DETRIMENTAL Rating 5

  • The evidence based protocol will be implemented over 4 three week periods in a surgical ICU starting 1 November 2008. Patient outcomes from protocol care will be compared to usual care.

  • The abdominal surgery; rehabilitation and pulmonary dysfunction groups are currently working on publications for submission this year.

Site content:

Why is it necessary to have an internationally validated best practice physiotherapy clinical algorithm?

The physiotherapist is regarded as an integral member of the multidisciplinary team involved in the management of patients in the ICU by both the European Society of Intensive Care Medicine ESICM (Ferdinande et al 1997) and the American College of Critical Care Medicine (1999). However the role of the physiotherapist in this environment is still largely undefined and varies across countries (Jones et al 1992, Norrenberg & Vincent 2000, Chaboyer et al 2004). This variation in practice has been related to staffing levels, training, and expertise (Clini & Ambrosino 2005). Variations in practice have been linked to less than optimal patient outcomes and increased cost (Kollef 1999).

A recent publication by Templeton et al (2007) in a high impact journal (Impact factor: 4.406. Ranked 3rd of 18 in "Critical care medicine") the researchers indicated that chest physiotherapy prolongs the duration of ventilation in critically ill patients that have been ventilated for more than 48 hours. These authors suggest that simple suctioning and decubitus positioning is at least as effective as CPT in this population. Eventhough these authors did attempt to identify possible confounders at baseline, the physiotherapy intervention provided were not recorded. Because the data for this study was collected almost 12 years ago over a four year period between November 1996 and January 2000 it is safe to assume that evidence with regards to positioning; use of MHI; early mobilization that have been published since 2000 (Hanekom et al 2007) were not incorporated into the physiotherapy intervention. It is noteworthy that the physiological measures investigated in the majority of this research improved post physiotherapy, but whether this will translate to improved patient outcome, is still unknown.

To provide the profession with evidence for the continued or alternative role of the physiotherapist within an ICU it is necessary to evaluate the effect of a service incorporating the best available current evidence, on the outcome of patients from ICU (Gosselink et al 2008).

Barriers to the implementation of evidence into practice have been widely reported (Bithell 2000; Grimmer et al 2004). The algorithms developed through this process should not be regarded as recipes as it does not replace the clinical judgment of the therapist or the interdisciplinary discussions with team members. It does provide a practical framework for decision making, providing the therapist with the tools to make informed decisions based on current available best evidence (Holohan et al 2006).

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