van der Lee Lisa, Hill Anne-Marie, Patman Shane
School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia.
Intensive Care Unit, Fiona Stanley Hospital Perth, Australia.
J Eval Clin Pract. 2019 Apr;25(2):230-243. doi: 10.1111/jep.13077. Epub 2018 Dec 19.
Patients with community-acquired pneumonia (CAP) are frequently admitted to an intensive care unit. Physiotherapy may be provided to optimize respiratory function; however, there is significant variability in clinical practice and limited research directing best practice for this cohort. This study aimed to determine expert consensus for best physiotherapy practice for invasively ventilated adults with CAP.
A modified Delphi technique involved an international expert panel completing three rounds of an online questionnaire. The initial 35-statement questionnaire, based on a systematic literature review and survey of current clinical practice, covered physiotherapy assessment and treatment of intubated patients with CAP. Quantitative data using Likert scales determined level of agreement, with qualitative data collected through open-ended responses. Consensus threshold was set a priori at 70%. Items not achieving consensus were modified and new items added based on themes from qualitative data. Quantitative data were analysed descriptively, with thematic analysis used on qualitative data.
The panel comprised 29 international clinical and academic experts in critical care physiotherapy. Response rate was more than 95% for each round. Outcome achieved was 38 consensus statements covering assessment and treatment, with 28 statements (74%) providing consensus on recommended clinical practice, two consensus disagreement statements (7%) for what practice is not recommended, and eight statements (21%) indicating which treatments may be beneficial.
Expert consensus regarding physiotherapy for intubated adults with CAP patients provides an evidence-based approach to guide clinical practice. The consensus statements can also be used to guide research evaluating physiotherapy interventions for patients with CAP.
社区获得性肺炎（CAP）患者常被收入重症监护病房。可能会提供物理治疗以优化呼吸功能；然而，临床实践存在显著差异，且针对该人群的最佳实践的研究有限。本研究旨在确定针对有创通气的CAP成年患者最佳物理治疗实践的专家共识。
采用改良德尔菲技术，由一个国际专家小组完成三轮在线问卷。基于系统文献综述和当前临床实践调查的初始35项问卷，涵盖了对插管CAP患者的物理治疗评估和治疗。使用李克特量表的定量数据确定共识水平，通过开放式回答收集定性数据。共识阈值预先设定为70%。未达成共识的项目进行修改，并根据定性数据中的主题添加新项目。定量数据进行描述性分析，定性数据采用主题分析。
该小组由29名重症监护物理治疗领域的国际临床和学术专家组成。每轮的回复率均超过95%。达成的结果是38条涵盖评估和治疗的共识声明，其中28条声明（74%）就推荐的临床实践达成共识，两条共识分歧声明（7%）涉及不推荐的实践，八条声明（21%）指出哪些治疗可能有益。
关于有创通气的CAP成年患者物理治疗的专家共识提供了一种循证方法来指导临床实践。这些共识声明也可用于指导评估CAP患者物理治疗干预的研究。
