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The validation of a clinical algorithm for the prevention and management of pulmonary dysfunction in intubated adults – a synthesis of evidence and expert opinion

Authors

  • Susan Hanekom MSc PhD registered,

    1. Senior Lecturer, Division of Physiotherapy, Department of Interdisciplinary Health Sciences, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa
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  • Sue Berney MSc PhD registered,

    1. Honorary Fellow, University of Melbourne, Senior Physiotherapist, ICU, Austin Health, Melbourne, Australia
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  • Brenda Morrow PhD,

    1. Senior Lecturer and MRC Career Award Fellow, Division of Paediatric Critical Care and Children's Heart Disease, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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  • George Ntoumenopoulos PhD,

    1. Consultant Physiotherapist Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
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  • Jennifer Paratz PhD,

    1. Specialist Cardiorespiratory Physiotherapist, Chair and Research Fellow, Burns, Trauma and Critical Care Research Centre, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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  • Shane Patman PhD,

    1. Specialist Cardiorespiratory Physiotherapist, Associate Professor, Physiotherapy, Cardiorespiratory Physiotherapy Stream Leader, School of Health Sciences, The University of Notre Dame Australia, Sydney, New South Wales, Australia
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  • Quinette Louw PhD

    1. Professor, Division of Physiotherapy, Department of Interdisciplinary Health Sciences, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Susan Hanekom, Division of Physiotherapy, Department of Interdisciplinary Health Sciences, Faculty of Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg 7505, South Africa. E-mail: sdh@sun.ac.za

Abstract

Background  Pulmonary dysfunction (PDF) in intubated patients remains a serious and costly complication of intensive care unit care. Optimal cardiopulmonary therapy strategies to prevent and manage PDF need clarification to reduce practice variability. The purpose of this paper is to report on the content validation of an evidence-based clinical management algorithm (EBCMA) aimed at the prevention, identification and management of PDF in critically ill patients.

Methods  Forty-four draft algorithm statements extracted from the extant literature by the primary research team were verified and rated by research clinicians (= 7) in an electronic three-round Delphi process. Statements which reached a priori defined consensus [semi-interquartile range (SIQR) <0.5] were collated into the EBCMA.

Results  One hundred per cent response rate. Forty-four statements were added after round one. Consensus was reached on rating of 83% (73/88) statements. Differences in interpretation of the existing evidence base, and variations in accepted clinical practice were identified. Four themes were identified where panel failed to reach consensus.

Conclusion  The internationally agreed hierarchical framework of current available evidence and clinical expertise developed through this Delphi process provides clinicians with a tool to inform clinical practice. This tool has the potential to reduce practice variability thereby maximizing safety and treatment outcome. The clinical utility of the EBCMA requires further evaluation.

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