Abstract：
Patients hospitalised with community-acquired pneumonia (CAP) are frequently admitted to an intensive care unit (ICU) for invasive mechanical ventilation and receive treatment by physiotherapists. However, clinical physiotherapy practice is variable for this ICU cohort.
To develop a clinical practice guideline for physiotherapy management of adults invasively ventilated with CAP using the best available evidence.
Guideline development using evidence synthesis according to the GRADE and JBI approaches, incorporating findings from four preceding phases of a mixed-methods research program: systematic review and meta-analysis, national survey of Australian ICU physiotherapy practice, e-Delphi study to determine expert consensus, and multidisciplinary peer-review of the expert consensus statements by senior ICU clinicians to determine validity and applicability of the statements for translation into practice.
The guideline comprises 26 recommendations, encompassing physiotherapy assessment, patient selection and prioritisation, and treatment. Physiotherapy treatment covers domains of humidification, patient positioning, hyperinflation techniques, manual chest wall techniques, normal saline instillation, active treatment, and mobilisation. Recommendations are rated as strong or conditional based on JBI criteria, and certainty of evidence according to GRADE. Considerations for practice are provided within the guideline to enhance clarity and practicality, particularly for conditional recommendations where evidence is limited or conflicting.
This guideline, based on the best available evidence for clinical physiotherapy practice for adults invasively ventilated with CAP, is intended to support clinicians with clinical decision making. Further research is required to evaluate guideline implementation into clinical practice, and incorporate the values and preferences of ICU patients and their families. CONTRIBUTION OF PAPER.
To develop a clinical practice guideline for physiotherapy management of adults invasively ventilated with CAP using the best available evidence.
Guideline development using evidence synthesis according to the GRADE and JBI approaches, incorporating findings from four preceding phases of a mixed-methods research program: systematic review and meta-analysis, national survey of Australian ICU physiotherapy practice, e-Delphi study to determine expert consensus, and multidisciplinary peer-review of the expert consensus statements by senior ICU clinicians to determine validity and applicability of the statements for translation into practice.
The guideline comprises 26 recommendations, encompassing physiotherapy assessment, patient selection and prioritisation, and treatment. Physiotherapy treatment covers domains of humidification, patient positioning, hyperinflation techniques, manual chest wall techniques, normal saline instillation, active treatment, and mobilisation. Recommendations are rated as strong or conditional based on JBI criteria, and certainty of evidence according to GRADE. Considerations for practice are provided within the guideline to enhance clarity and practicality, particularly for conditional recommendations where evidence is limited or conflicting.
This guideline, based on the best available evidence for clinical physiotherapy practice for adults invasively ventilated with CAP, is intended to support clinicians with clinical decision making. Further research is required to evaluate guideline implementation into clinical practice, and incorporate the values and preferences of ICU patients and their families. CONTRIBUTION OF PAPER.
摘要：
方法：社区获得性肺炎（CAP）住院的患者经常进入重症监护病房（ICU）进行有创机械通气，并接受物理治疗师的治疗。然而,该ICU队列的临床物理治疗实践是可变的。
目的：利用现有的最佳证据，为成人CAP侵入性通气的理疗管理制定临床实践指南。
方法：根据GRADE和JBI方法使用证据合成开发指南，纳入混合方法研究计划的前四个阶段的发现：系统回顾和荟萃分析，澳大利亚ICU物理治疗实践的全国调查，e-Delphi研究确定专家共识，并由ICU高级临床医生对专家共识声明进行多学科同行评审，以确定声明的有效性和适用性，以转化为实践。
结果：该指南包括26条建议，包括物理治疗评估，患者选择和优先排序，和治疗。物理治疗包括湿化领域，患者定位,恶性通货膨胀技术，手动胸壁技术，生理盐水滴注，积极治疗,和动员。根据JBI标准，建议被评为强或有条件的，根据等级确定证据。在准则中提供了实践考虑，以提高清晰度和实用性，特别是对于证据有限或冲突的有条件建议。
结论：本指南，根据现有的最佳证据，为成人接受CAP侵入性通气的临床物理治疗实践，旨在为临床医生提供临床决策支持。需要进一步的研究来评估指南在临床实践中的实施情况。并纳入ICU患者及其家属的价值观和偏好。论文的贡献。
目的：利用现有的最佳证据，为成人CAP侵入性通气的理疗管理制定临床实践指南。
方法：根据GRADE和JBI方法使用证据合成开发指南，纳入混合方法研究计划的前四个阶段的发现：系统回顾和荟萃分析，澳大利亚ICU物理治疗实践的全国调查，e-Delphi研究确定专家共识，并由ICU高级临床医生对专家共识声明进行多学科同行评审，以确定声明的有效性和适用性，以转化为实践。
结果：该指南包括26条建议，包括物理治疗评估，患者选择和优先排序，和治疗。物理治疗包括湿化领域，患者定位,恶性通货膨胀技术，手动胸壁技术，生理盐水滴注，积极治疗,和动员。根据JBI标准，建议被评为强或有条件的，根据等级确定证据。在准则中提供了实践考虑，以提高清晰度和实用性，特别是对于证据有限或冲突的有条件建议。
结论：本指南，根据现有的最佳证据，为成人接受CAP侵入性通气的临床物理治疗实践，旨在为临床医生提供临床决策支持。需要进一步的研究来评估指南在临床实践中的实施情况。并纳入ICU患者及其家属的价值观和偏好。论文的贡献。
