Pre-operative | Intra-operative | Post-operative | |
---|---|---|---|
In the care bundle | • Supervised exercise programme • Inspiratory muscle training (*) | • Low tidal volume ventilation (**) with individualised PEEP • Use of routine monitoring to avoid hyperoxia • Limit NM blockade | • Deep breathing exercises • Mandatory elevation of the head of the bed |
Not in the care bundle | • Oropharyngeal decontamination • Oral care package • Chlorhexidine mouthwash or other selective oral decontamination • Selective digestive decontamination • Incentive spirometry • Deep breathing exercises • Daily pedometer targets | • Recruitment manoeuvres • Routine use of high levels of PEEP • Use of endotracheal tubes with specific design features, including subglottic secretion drainage • Specific drugs or techniques to limit residual neuromuscular blockade | • Prophylactic ventilator support including CPAP, NIV or high-flow nasal oxygen • Pharmacological therapies that aim to decrease gastro-oesophageal reflux |