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:


AGREE Collaboration. 2001 The Appraisal of Guidelines for Research & Evaluation (AGREE) Instrument. London: The AGREE Research Trust.

American College of Critical Care Medicine of the Society of Critical Care Medicine 1999 Critical Care services and personnel: recommendations based on a system of categorization into two levels of care. Critical Care Medicine 27:422-426

Bithell C 2000 Evidence Based Physiotherapy. Physiotherapy 86(2):58-60

Chaboyer W, Gass E, Foster M 2004 Patterns of chest physiotherapy in Australian Intensive Care Units. Journal of  Critical Care. 19:145-51.

Clini E & Ambrosino N 2005 Early physiotherapy in the respiratory intensive care unit. Respiratory Medicine 99:1096-1104

Ferdinande P & Members of Task Force of the European Society of Intensive Care Medicine 1997 Recommendations on minimal requirements for Intensive Care Departments. Intensive Care Medicine 23:226-232

Gosselink R., Bott J.,  Johnson M., Dean E., et al 2008 Physiotherapy for adult patients with critical illness:Recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Medicine E publication

Grimmer K., Bialocerkowski A., Kumar S., Milanese S. 2004 Implementing evidence in clinical practice: the ‘therapies’ dilemma. Physiotherapy 90:189–194

Hanekom SD, Coetzee AR, Faure MR 2006 Outcome evaluation of a South African ICU – a baseline study. South African Journal Critical Care 22(1):14-20

Hanekom S.D., Faure M., Coetzee A. 2007 Outcomes research in the ICU: an aid in defining the role of physiotherapy. Physiother Theory Practice 23:125-35

Holohan V.,Deenadayalan Y., Grimmer K. 2006 Evidence based physiotherapy for acute low back pain: A composite clinical algorithm synthesized from seven recent clinical guidelines. Physiotherapy Canada

Jones A, Hutchinson R, Oh T 1992 Chest physiotherapy practice in intensive care units in Australia, the UK and Hong Kong. Physiotherapy Theory and Practice 8:39-47

Keeney. S, Hasson F., and McKenna H. 2006 Consulting the oracle: ten lessons from using the Delphi technique in nursing research. Journal of Advanced Nursing 53:205-12

Kollef  MH 1999 Improving outcomes in the ICU setting. Chest 115:1490-1492

Lathyris D.N., Trikalinos T.A., Ioannidis J.P. 2007 Evidence from crossover trials: empirical evaluation and comparison against parallel arm trials. International Journal of Epidemiology 36:422–430

Norrenberg M & Vincent JL 2000 A profile of European intensive care unit physiotherapists. Intensive Care Medicine 26:988-994

Oxman A.D., Lavis J.N., Fretheim A. 2007 Use of evidence in WHO recommendations. World Hospital Health Service 43:14-20

Schünemann H.J., Jaeschke R., Cook D.J., Bria W.F. et al  2005 An Official ATS Statement: Grading the Quality of Evidence and Strength of Recommendations in ATS Guidelines and Recommendations. American Journal of Respiratory Critical Care Medicine 174:605–614

Schünemann H.J., Fretheim  A. and Oxman A. 2006 Improving the use of research evidence in guideline development: 9. Grading evidence and recommendations. Health Research Policy and Systems 4:21

Shea B.J., Bouter L.M., Peterson J., Boers M., Andersson N., et al 2007 External Validation of a Measurement Tool to Assess Systematic Reviews (AMSTAR). PLoS ONE 2:e1350

Shea  B.J., Grimshaw J.M., Wells M.B., et al 2007 Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Medical Research Methodology 7:10

Templeton M. and Palazzo M.  2007 Chest physiotherapy prolongs duration of ventilation in the critically ill ventilated for more than 48 hours. Intensive Care Medicine 33:1938–1945

Van der Wees P.J., Hendriks E.J., Custers W.H. et al 2007   Comparison of international guideline programs to evaluate and update the Dutch program for clinical guideline development in physical therapy. BMC Health Services Research 7:191

Wall RJ, Dittus RS, Ely WE  2001 Protocol-driven care in the intensive care unit: a tool for quality Critical Care 5:283–285

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