1. CLINICAL ALGORITHM FOR THE MANAGEMENT OF NON INTUBATED PATIENT FOLLOWING ABDOMINAL SURGERY Next step in the algorithm

2. Can this pt cough effectively? Recommendation 1 YESNO

3.  Position pt in high sitting over the side of the bed  Teach pt to huff / cough with wound support  If unsuccessful: suction patient through mouth piece Recommendation 1 Next step in the algorithm

4.  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 1 RCT YESNO

5. Use Breathing techniques:  Position pt in high sitting over the side of the bed / Long sitting in bed  Use any of the following techniques based on pt performance: CPAP Intermittently CPAP Intermittently PEP mask PEP mask IPPB IPPB PEEP Bottle PEEP Bottle IS Recommendation 1 IS Recommendation 1  Frequency: at least one maximal inspiratory effort at least one maximal inspiratory effort at least once a day for first three days post operatively Hall 96 1 RCT at least once a day for first three days post operatively Hall 96 1 RCT Back to algorithm

6. Initiate directed mobilization program  Pt to reach at least one of these goals with each treatment session: Sit out of bed Sit out of bed Walk 5 m with assistance Walk 5 m with assistance Walk 15 m with assistance Walk 15 m with assistance Walk 30 m with assistance Walk 30 m with assistance Walk 30 m without assistance. Walk 30 m without assistance. Progression based on walking intensity of 6/10 on Borg Scale Progression based on walking intensity of 6/10 on Borg Scale Active dorsiflexion while in bed at least 20 times every waking hour Active dorsiflexion while in bed at least 20 times every waking hour  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 RCT McKay 2005 1 RCT Back to algorithm