title: The validation of a clinical algorithm for the prevention and management of pulmonary dysfunction in intubated adults--a synthesis of evidence and expert opinion.
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 (n = 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Physiotherapy, Department of Interdisciplinary Health Sciences, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa. sdh@sun.ac.za
authors.forename: Susan
authors.initials: S
authors.lastname: Hanekom
authors.forename: Sue
authors.initials: S
authors.lastname: Berney
authors.forename: Brenda
authors.initials: B
authors.lastname: Morrow
authors.forename: George
authors.initials: G
authors.lastname: Ntoumenopoulos
authors.forename: Jennifer
authors.initials: J
authors.lastname: Paratz
authors.forename: Shane
authors.initials: S
authors.lastname: Patman
authors.forename: Quinette
authors.initials: Q
authors.lastname: Louw
mesh_terms: D000328:Adult; D000465:Algorithms; D003697:Delphi Technique; D019317:Evidence-Based Medicine; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy*