CLINICAL ALGORITHM CLINICAL ALGORITHM FOR THE MANAGEMENT FOR THE MANAGEMENT

OF NON INTUBATED OF NON INTUBATED PATIENT FOLLOWING PATIENT FOLLOWING

ABDOMINAL SURGERYABDOMINAL SURGERY

Next step in the algorithm

Can this pt cough effectively?Can this pt cough effectively?Recommendation 1Recommendation 1

YESNO

Position pt in high sitting over the side of the bedPosition pt in high sitting over the side of the bed Teach pt to huff / cough with wound supportTeach pt to huff / cough with wound support If unsuccessful: suction patient through mouth pieceIf unsuccessful: suction patient through mouth piece

Recommendation 1

Next step in the algorithm

At rest pt is presenting with: At rest pt is presenting with: stable blood pressure and heart rate, stable blood pressure and heart rate, no dyspnoea and no dyspnoea and less than 8/10 rating on pain scale less than 8/10 rating on pain scale

McKay 2005 McKay 2005 1 RCT1 RCT

YESNO

Use Breathing techniquesUse Breathing techniques: : Position pt in high sitting over the side of the bed / Long Position pt in high sitting over the side of the bed / Long

sitting in bedsitting in bed Use any of the following techniques based on pt Use any of the following techniques based on pt

performance:performance: CPAP IntermittentlyCPAP Intermittently PEP maskPEP mask IPPBIPPB PEEP BottlePEEP Bottle IS IS Recommendation 1Recommendation 1

FrequencyFrequency: : at least one maximal inspiratory effort at least one maximal inspiratory effort at least once a day for first three days post operatively at least once a day for first three days post operatively

Hall 96 1 RCTHall 96 1 RCT

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Initiate directed mobilization programInitiate directed mobilization program

Pt to reach at least one of these goals with each treatment session:Pt to reach at least one of these goals with each treatment session: Sit out of bedSit out of bed Walk 5 m with assistanceWalk 5 m with assistance Walk 15 m with assistanceWalk 15 m with assistance Walk 30 m with assistanceWalk 30 m with assistance Walk 30 m without assistance.Walk 30 m without assistance. Progression based on walking intensity of 6/10 on Borg ScaleProgression based on walking intensity of 6/10 on Borg Scale Active dorsiflexion while in bed at least 20 times every waking hourActive dorsiflexion while in bed at least 20 times every waking hour

Frequency: Frequency: Days one and two (three times / day)Days one and two (three times / day) Day 3 (two times per day) Day 3 (two times per day)

McKay 2005 1 RCTMcKay 2005 1 RCT

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