Original article
Interevaluator reliability of a tool for measuring body height in adult intensive care patients
Confiabilidad interevaluador de una herramienta para la medición de la estatura corporal en pacientes adultos en una unidad de cuidado intensivo
H.A. Payán-Salcedoa,b,c,
, J.L. Estela-Zapeb,d, L.P. Chanchi-Quinteroa,e, E.C. Wilches-Lunaa,c
Corresponding author
a Faculty of Health, Universidad del Valle, Cali 760042, Colombia
b Faculty of Health, Physiotherapy Program, Universidad Santiago de Cali, Cali 760035, Colombia
c Exercise and Cardiopulmonary Health Research Group (GIESC), Universidad de Valle, Cali 760042, Colombia
d Faculty of Health Sciences, Fundación Universitaria Maria Cano, Cali 760528, Colombia
e Centro Médico Imbanaco, Cali 760042, Colombia
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"apellidos" => "Wilches-Luna" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Faculty of Health, Universidad del Valle, Cali 760042, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculty of Health, Physiotherapy Program, Universidad Santiago de Cali, Cali 760035, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Exercise and Cardiopulmonary Health Research Group (GIESC), Universidad de Valle, Cali 760042, Colombia" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Faculty of Health Sciences, Fundación Universitaria Maria Cano, Cali 760528, Colombia" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Centro Médico Imbanaco, Cali 760042, Colombia" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Confiabilidad interevaluador de una herramienta para la medición de la estatura corporal en pacientes adultos en una unidad de cuidado intensivo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1116 "Ancho" => 2091 "Tamanyo" => 96592 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Correlation of the measurement of body height in men.</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">R: Correlation coefficient.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0005"></elsevierMultimedia></p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Implications of the study</span></p><p id="par0030" class="elsevierStylePara elsevierViewall">Accurately obtain body height and therefore, ideal body weight; which will allow the tidal volume to be adjusted to the physiological requirements of each patient, constituting a safe clinical practice.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0035" class="elsevierStylePara elsevierViewall">The ideal weight has wide applicability that extends from the nutritional and sports medical fields to clinical contexts in areas of pharmacology, clinical nutrition and intensive care.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Various equations<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> have been used for decades to calculate the ideal weight, taking into account measurements such as height, actual body weight, ulnar length and even body mass index.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The proposed equations were designed and established based on characteristics of the population in which they were created and have been adopted as a standard measure in Spanish-speaking countries in the clinical and nutritional fields to objectively estimate ventilatory, pharmacological and nutritional strategies.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Specifically, in the context of the intensive care unit (ICU), the guidelines of the Acute Respiratory Distress Syndrome Network (ARDS Network) proposed an equation based on the measurement of body height for calculating the ideal weight of patients on mechanical ventilation derived from anthropometric measurements in the US population.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> According to some authors, it continues to be the gold standard for calculating the ideal weight in ICUs worldwide.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Payan et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> conducted a literature review to identify the evidence related to the use of equations for calculating the ideal weight in adult patients connected to mechanical ventilation in ICUs in Latin America, and the results showed that in 89% of the articles, the authors used the ARDS Network equation to calculate the ideal weight. Additionally, it was found that in many of these ICUs, there are no tools for obtaining body weight and height, such as hanging scales, beds with built-in scales and portable stadiometers, possibly due to their costs, and so visual and subjective estimates are used instead.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Maskin et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> published the results of a prospective study that determined the magnitude of errors in the visual estimation of weight and height of critically ill patients and concluded that weight estimation by ICU staff often is inaccurate, highlighting the need for objective measurements with calibrated instruments to achieve precision.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Alternatives to using equations to calculate the ideal weight require the measurement of height, which if it is not remembered by the patient cannot be obtained in any way other than by measurement or estimation; therefore, objective measurement body height with valid and reliable instruments is necessary. However, there is little literature on the design of measurement protocols for this anthropometric variable in critically ill patients.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Measurement is a fundamental component of good clinical practice, and the use of valid and reliable tests and measures is vital for making clinical decisions, maintaining quality of care, and determining clinical efficacy and patient safety. In this context, some authors agree that two of the properties needed for any measurement are reliability and validity.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> A reliable instrument measures a phenomenon consistently and systematically obtains the same results without variability.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The foregoing highlights the importance of protocolizing the measurement of height in critical patients for calculating the ideal weight objectively with the use of valid protocols and simple and inexpensive tools and evaluation of the most relevant psychometric properties. Therefore, the objective of this study was to determine the interrater reliability of a tool for measuring body height in adult patients in an ICU in southwestern Colombia.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0070" class="elsevierStylePara elsevierViewall">This observational cross-sectional study was approved by the Health Research Ethics Committee of a university (Cod: 070-020) and the health institution. The study complies with the Declaration of Helsinki. Informed consent was signed by the patient if the clinical condition allowed it or by the closest family member if the patient was not conscious or in a condition to consent, and the confidentiality and anonymity of the participants were ensured. This study followed the recommendations of Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Interrater reliability</span><p id="par0075" class="elsevierStylePara elsevierViewall">This study was carried out between January and May 2021. Two physiotherapists were trained in the application of the designed protocol, and a pilot test was carried out with a convenience sample of 30 patients. The approximate time for the application of the protocol was less than two minutes.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The interrater reliability study was conducted in a 40-bed multipurpose adult ICU in a third-level complexity clinic. The sample size was calculated using Pearson's correlation, based on a main objective of comparing 2 quantitative measurements to define their linear relationship. The calculated sample size was 106 patients, 53 men and 53 women, and taking into account the COSMIN checklist, it was considered an ideal sample size for calculating the interrater reliability.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The inclusion criteria were age older than 18 years and admission to the ICU regardless of the need for mechanical ventilation. Patients with musculoskeletal alterations that limited measuring height, those in whom the clinical condition restricted the adoption of the supine position with horizontalization of the bed and those under isolation due to infections by multidrug-resistant microorganisms or COVID-19 were excluded.</p><p id="par0090" class="elsevierStylePara elsevierViewall">To measure body height, the authors designed a protocol (appendix) based on the reference manual for anthropometric standardization by Lohman,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> recommended by the World Health Organization (WHO). The protocol incorporated the use of Wilchow boards, a tool designed by Wilches et al. (pending industrial property in Colombia) to simulate a stadiometer that would facilitate a more objective measurement of body height and minimize errors in the measurement.</p><p id="par0095" class="elsevierStylePara elsevierViewall">These boards are portable, lightweight, easy to disinfect, and made of firm and resistant wood in the shape of an “L” with a calibrated 90° bend. The boards are positioned with the patient horizontally, at the level of the cranial vertex and on the soles of both feet, leaving both ankles dorsiflexed at a 90° angle. Additionally, a standard rigid 5-m tape measure (30–497; Stanley, New Britain, USA) with a precision of 0.1 mm was used to take measurements with millimetre precision, as suggested by some authors.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Regarding the use of the boards, the endorsement of the institution's infection committee was obtained, and the recommendations for disinfection with quaternary ammonium (0.5%) were followed after each use.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Preparation of evaluators and pilot study</span><p id="par0105" class="elsevierStylePara elsevierViewall">The 2 physiotherapists responsible for the measurements underwent training in the application of the protocol, and each professional assessed each patient and recorded the duration, execution, comments and questions generated during the process. The patients evaluated in this pilot test had characteristics similar to those in the sample. The pilot test allowed us to apply the protocol in less than two minutes, and the evaluators agreed that the measurement was easy to perform and did not report difficulties or adverse events such as disconnection of equipment or haemodynamic instability during the measurement.</p><p id="par0110" class="elsevierStylePara elsevierViewall">To calculate reliability, the two physiotherapists (evaluator 1 and evaluator 2) with more than 3 years of experience in the care of critical patients performed the measurements independently on the same patient once each-, with an interval of three minutes between each measurement, following the standardized protocol. Before the measurement, the haemodynamic, psychic and motor stability of the patient were evaluated, and the measurements were performed with continuous heart rate, arterial oxygen saturation (SaO2), and blood pressure monitoring and electrocardiographic tracing.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The information collection forms were completed separately, without communication between the evaluators. Once the measurements were completed, each evaluator placed the collection form in an envelope identified as evaluator 1 or evaluator 2, which was sealed and stored in a box that could only be accessed by the principal investigator.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The two physiotherapists and the ICU work team were masked, and once a patient was included in the study, they were unaware of the height measurement reported by the ICU health care team.</p><p id="par0125" class="elsevierStylePara elsevierViewall">To ensure the quality of the data collected, the principal investigator reviewed the information in each record form once a week. After verifying the information in the data collection forms, data entry was carried out in a database prepared in Excel version 2016 (Microsoft, United States), and quality control was carried out in the data entry by an external person who did not participate in the collection.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0130" class="elsevierStylePara elsevierViewall">Statistical analyses were conducted in SPSS 25.0 (IBM, United States). Categorical variables are expressed as frequencies and percentages, and continuous variables are expressed as the mean and standard deviation (SD).</p><p id="par0135" class="elsevierStylePara elsevierViewall">The interrater reliability between rater 1 and 2 was calculated from the intraclass correlation coefficient (ICC), which ranges between 0 and 1, where 0 indicates the greatest disagreement and 1 indicates perfect agreement.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Once the reliability value was obtained, the measurements for men and women were compared with the independent samples Student's t for variables that behaved according to a normal distribution (Shapiro–Wilk test) and with homogeneity of variance (Levene’s test). Concordance was assessed with Bland–Altman analysis, and the correlation was measured by means of the Pearson test. Statistical significance was established according to the 95% confidence interval (95% CI) and a significance level of <span class="elsevierStyleItalic">p</span> < 0.05. For the interpretation of the ICC values, the classification of Landis and Koch<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> was employed (0: poor; 0.01−0.20: mild; 0.21−0.40: regular; 0.41−0.60: moderate; 0.61−0.80: substantial; 0.81−1.00: almost perfect). To check the agreement between the evaluators, the kappa index was used, which takes on values from 0 to 1, where 0 indicates the greatest disagreement and 1 indicates perfect agreement. Qualitatively, values greater than 0.8 were considered excellent, values greater than 0.7 were considered strong, and values greater than 0.6 were considered good.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0145" class="elsevierStylePara elsevierViewall">During the data collection period, 106 patients were included. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the recruitment flow chart for the participants. Over the 5 months of the study period, 1479 patients were admitted to the ICU. Of these, 616 were not evaluated because their stay in the ICU was less than 72 h; 561 were excluded due to viral pneumonia related to COVID-19, and 90 patients were excluded due to infection by multidrug-resistant microorganisms.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">Fifty percent of the sample were male, and 50% were female. The mean age was 59.3 years for women (SD: 16.71) and 56.8 years for men (SD: 17.6).</p><p id="par0155" class="elsevierStylePara elsevierViewall">Regarding the presence of ventilatory support during the measurement, 40 women and 41 men were connected to mechanical ventilation.</p><p id="par0160" class="elsevierStylePara elsevierViewall">The average body height was 170.5 (±7.0) cm for men and 158,5 (±7.5) cm for women.</p><p id="par0165" class="elsevierStylePara elsevierViewall">The results indicated excellent interrater reliability for the body height measurement between Rater 1 and Rater 2 (ICC = 0.996; P = 0.000), as shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">When comparing the measurement of body height in men and women between the two evaluators (Student's <span class="elsevierStyleItalic">t</span>-test), no statistically significant differences were identified for either sex (men, P = 0.940; women, <span class="elsevierStyleItalic">P</span> = 0.952).</p><p id="par0175" class="elsevierStylePara elsevierViewall">The kappa index was greater than 0.95 for both scales. The results of the Bland‒Altman analysis showed that the behaviour of the differences around zero was uniform; in addition, there was very good agreement in the measurements of body height in men (average = 0.11, SD: 0.75) and women (average = 0.092, SD = 0.96) (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>). An excellent statistical correlation was also obtained in the measurement of body height for both men and women (R = 0.99 for both), as shown in <a class="elsevierStyleCrossRefs" href="#fig0020">Figs. 4 and 5</a>.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0180" class="elsevierStylePara elsevierViewall">The objective of this study was to determine the interrater reliability of the measurement of body height in critically ill patients, and the results showed excellent interrater reliability. The authors consider that standardization, precision and training guaranteed this reliability and that the designed protocol can be a useful tool to guide the calculation of the ideal weight in the context of intensive care.</p><p id="par0185" class="elsevierStylePara elsevierViewall">In this study, 50% of the patients evaluated were men, with an average body height of 170.5 cm, while that in women was 158.5 cm. The sample size (<span class="elsevierStyleItalic">n</span> = 106) reached was that suggested by the COSMIN checklist for reliability studies,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and 76% of the patients were on mechanical ventilation at the time of measurement. The authors consider that this reflects the real context of the ICU and avoided selection biases that could interfere with the results.</p><p id="par0190" class="elsevierStylePara elsevierViewall">Regarding the design of the protocol for measuring body height in critically ill patients, a literature review identified publications focused on anthropometric measurements in the ICU, but no standardized protocols were described. In the present study, the protocol included the use of a standardized 5 m tape measure and the Wilchow boards, based on the results reported by O'Brien D et al.,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> who reported that the measurement of body height in the ICU may be influenced by errors associated with body folds and suggested the use of measuring tapes with a length greater than 2 m. In this research, the use of the Wilchow boards avoided contact with body folds, which could influence the results between one professional and another, and the authors consider that this favoured a reduction in biases related to the measurements.</p><p id="par0195" class="elsevierStylePara elsevierViewall">García del Moral et al.,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> in a prospective cohort study in 28 ICU patients, compared the measurements of real weight and body height with their visual estimates and found a poor concordance for the two parameters. These authors consider that although weight and body height are important measurements in the ICU, little attention is given to them, and there is substantial subjectivity, for which they suggest that in the context of the ICU, validated and reliable tools that reduce the margin of error in the measurement should be employed.</p><p id="par0200" class="elsevierStylePara elsevierViewall">Given the need to standardize the measurement of height in critically ill patients, the designed protocol is supported by scientific evidence related to the subject; the guidelines and recommendations of the Lohman criteria<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> were adopted and adapted to the context of the critical patient by using low-cost and easily available instruments. The authors of the study consider that a standardized protocol reduces the variability between evaluators and that it is necessary to standardize the processes of patient care, which implies a change in culture, both organizational and professional, allowing homogenization of the knowledge of the health care staff and an understanding of the benefits of the use of these instruments.</p><p id="par0205" class="elsevierStylePara elsevierViewall">For the authors of the present study, the designed protocol may be appropriate as a useful tool for facilitating the measurement of height for subsequently calculating the ideal weight in critically ill patients, favouring decision-making, helping to maintain the quality of care and decreasing the subjectivity in the measurement.</p><p id="par0210" class="elsevierStylePara elsevierViewall">In this study, excellent interrater reliability was observed in the measurement of height, and differences between rater 1 and rater 2 were not significant. This could be related to their training, adequate learning and clinical experience. Singh et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> determined the interrater reliability in measuring body height in the supine position from a measurement of ulnar length and tibial length with a 1.5 m tape measure in 100 patients connected to mechanical ventilation, and the results showed ICCs of 0.88, 0.95 and 0.97, respectively. In the present study, patients on mechanical ventilation were also measured, but the reliability of the measurement was only evaluated with a tape measure while the patient was in the supine position. The resulting ICC was 0.99, but unlike in Singh et al.,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> a standardized protocol was used, which included the use of Wilchow boards. The authors of this research consider that given inability to use beds with scales, the Wilchow boards that resemble stadiometers allow the measurement of height in maximum extension, ensuring the Frankfort plane, which could have favoured reliability in the results obtained.</p><p id="par0215" class="elsevierStylePara elsevierViewall">Finch et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> conducted an investigation in 24 healthy adult volunteers simulating positions taken by patients with muscle contractures, seeking to evaluate the precision and interrater reliability in the measurement of body height in bed with a new method, following a protocol that uses 150 cm nonstretchable tubes, standard tape measures and markers. Four evaluators (3 dietitians and 1 physiotherapist) performed the measurements with the patients in 3 different positions and obtained an interevaluator reliability of 0.94 and the corresponding 95% confidence interval using the ICC, similar to the results of the present investigation, indicating excellent reliability when measuring height when following a measurement protocol.</p><p id="par0220" class="elsevierStylePara elsevierViewall">The measurement of body height in critically ill patients can be very important, since in some situations, the calculation of weight is not easily obtained by direct methods, such as for hospitalized patients, in which conditions such as mechanical ventilation or compromised consciousness limit mobility or the ability to stand.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,20</span></a> Therefore, some researchers<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21–23</span></a> have developed and proposed equations for the calculation of ideal weight that include anthropometric variables such as height, weight or the measurements of a body segment.</p><p id="par0225" class="elsevierStylePara elsevierViewall">The methodological strengths of the study include the use of a standardized measurement protocol that incorporates simple, easily accessible instruments (Wilchow boards and tape measures), the implementation of measurement training protocols for the raters, the use of strategies for reducing the possibility of information and selection biases, and the control of confounding factors, such as the masking of the measurement results and the quality control carried out to the information collection and analysis processes.</p><p id="par0230" class="elsevierStylePara elsevierViewall">Future multicentre studies are recommended that compare the measurements obtained with the designed protocol, the standard method (stadiometer) and other variables, such as ulnar length, leg length and arm/mid-arm length.</p><p id="par0235" class="elsevierStylePara elsevierViewall">The present study should be considered a referential framework in our environment, as it provides a protocol for measuring body height in critically ill patients and could standardize this measurement and favour decision-making not only by physiotherapists but also by other professionals, to improve clinical practice and offer safe and quality care. In addition, the importance of anthropometric measurements (weight and height) in the context of intensive care is evidenced by its implication in clinical decision-making. However, there are no guidelines defined in existing clinical practice guidelines for obtaining these measurements in the context of the ICU.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Limitations</span><p id="par0240" class="elsevierStylePara elsevierViewall">The limitations of the study are related to the scarcity of literature related to the interevaluator reliability of the measurement of body height in the ICU, which facilitated the discussion of the results obtained, and to the failure to take into account other professionals of the ICU team who could also use the protocol.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusion</span><p id="par0245" class="elsevierStylePara elsevierViewall">Excellent interrater reliability (global ICC of 0.99, <span class="elsevierStyleItalic">p</span> < 0.000) in the measurement of body height was observed between the two raters with the use of a protocol that incorporates Wilchow boards and a tape measure.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interest statement</span><p id="par0250" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Sources of funding</span><p id="par0255" class="elsevierStylePara elsevierViewall">This research has not received specific support from public sector agencies, the commercial sector or non-profit entities.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres2130651" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1809502" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2130652" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1809503" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Interrater reliability" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Preparation of evaluators and pilot study" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Limitations" ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusion" ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of interest statement" ] 11 => array:2 [ "identificador" => "sec0055" "titulo" => "Sources of funding" ] 12 => array:2 [ "identificador" => "xack739333" "titulo" => "Acknowledgments" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-12-08" "fechaAceptado" => "2024-01-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1809502" "palabras" => array:6 [ 0 => "Body height" 1 => "Anthropometry" 2 => "Ideal body weight" 3 => "Respiration" 4 => "Artificial" 5 => "Protocols" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1809503" "palabras" => array:5 [ 0 => "Estatura corporal" 1 => "Antropometría" 2 => "Peso corporal ideal" 3 => "Ventilación mecánica" 4 => "Protocolos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The calculation of body height in the intensive care unit is essential for obtaining the ideal body weight, which is used to program the tidal volume and establish objective and effective pulmonary ventilation. The objective of the study was to determine the interrater reliability of a tool for measuring body height in adult patients in an intensive care unit (ICU) in southwestern Colombia.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">This cross-sectional observational study was conducted between January and May 2021, following the recommendations of the COSMIN protocol. Two physiotherapists in the roles of observer/evaluator measured the heights of 106 patients upon admission to the ICU with a previously designed. The sample size was calculated based on Pearson's correlation coefficient. For interrater reliability, the intraclass correlation coefficient (ICC) was used, and Bland–Altman analysis was used to assess concordance. The 95% confidence interval was established, and a P value <0.05 indicated statistical significance.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">A total of 106 individuals with a mean age of 59.3 years were included; the mean body height was 158.5 cm for women. The interrater reliability of the measurement of height was excellent (global ICC of 0.99, <span class="elsevierStyleItalic">P</span> = 0.000), and an almost perfect positive correlation was obtained between the raters for both women and men (<span class="elsevierStyleItalic">R</span> = 0.99).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Excellent interrater/interobserver reliability was obtained for the measurement of body height in the ICU. This research highlights the importance of protocolizing the measurement of height in critical patients with valid and reliable instruments.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">El cálculo de la estatura corporal en la Unidad de Cuidado Intensivo es imprescindible para obtener el peso corporal ideal, usado para programar el volumen corriente y establecer una ventilación pulmonar objetiva y efectiva. El objetivo del estudio fue determinar la confiabilidad inter evaluador de una herramienta para medición de la estatura corporal en pacientes adultos en una unidad de cuidado intensivo en el suroccidente colombiano.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional de corte transversal, entre enero y mayo del 2021, siguiendo las recomendaciones del protocolo COSMIN. Dos fisioterapeutas con el rol observador/evaluador realizaron la medición de la estatura con un protocolo diseñado, en 106 pacientes al ingreso a UCI. El cálculo de muestra se realizó a partir del coeficiente de correlación de Pearson. Para la confiabilidad inter evaluador se usó el Coeficiente de Correlación Intraclase (ICC) y para la concordancia análisis de Blant-Altman. Se estableció intervalo de confianza del 95% y valor de P < 0.05.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Fueron incluidas 106 personas con edad media de 59.3 años; la media de estatura corporal fue 158.5 cm para mujeres. La confiabilidad inter evaluador de la medición de la estatura fue excelente (ICC global de 0.99, P = 0.000) y se obtuvo una correlación positiva casi perfecta tanto para mujeres como para hombres (R = 0.99).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Se obtuvo excelente confiabilidad inter evaluador (evaluador/observador) de la medición de la estatura corporal en UCI. Esta investigación resalta la importancia de protocolizar la medición de la estatura en el paciente crítico con instrumentos válidos y confiables.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0265" class="elsevierStylePara elsevierViewall">To measure body height, the following steps were followed:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0270" class="elsevierStylePara elsevierViewall">Verification of the haemodynamic condition of the patient.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0275" class="elsevierStylePara elsevierViewall">Positioning the patient in the supine position with the bed at zero degrees and without pillows.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0280" class="elsevierStylePara elsevierViewall">Verification of the absence of hyperextension or flexion of the neck.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0285" class="elsevierStylePara elsevierViewall">Verification of positioning of the legs fully extended and of the fibulotalar joint at a 90° angle.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0290" class="elsevierStylePara elsevierViewall">Positioning of the Wilchow boards at the levels of the cranial vertex and the soles of the feet (right and left).</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0295" class="elsevierStylePara elsevierViewall">Extension of the tape measure from the upper edge of the Wilchow board at the cranial vertex to the table at the feet.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">•</span><p id="par0300" class="elsevierStylePara elsevierViewall">Verification of the full extent of the tape measure before recording the measurement value in centimetres.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">•</span><p id="par0305" class="elsevierStylePara elsevierViewall">Recording of the value of body height</p></li></ul></p> <p id="par0310" class="elsevierStylePara elsevierViewall">Measurement protocol that includes Wilchow boards and measure tape.<elsevierMultimedia ident="fig0030"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Measurement protocol" "identificador" => "sec0060" ] ] ] ] "multimedia" => array:8 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2020 "Ancho" => 2091 "Tamanyo" => 205889 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient selection flow chart for data collection.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Design: authors.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 955 "Ancho" => 2091 "Tamanyo" => 87349 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Bland‒Altman graph of men’s body height measured by evaluators 1 and 2.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1050 "Ancho" => 2091 "Tamanyo" => 94462 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Bland‒Altman graph of women’s body height measured by evaluators 1 and 2.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1116 "Ancho" => 2091 "Tamanyo" => 96592 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Correlation of the measurement of body height in men.</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">R: Correlation coefficient.</p>" ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1181 "Ancho" => 2091 "Tamanyo" => 88364 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Correlation of the measurement of body height in women.</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">R: Correlation coefficient.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="8" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intraclass correlation coefficient</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"></th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ICC</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">F test (true value = 0)</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lower limit \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Upper limit \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">F value \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">gl 1 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">gl 2 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Individual measurements \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.996 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.994 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.997 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">509.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">105 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">105 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Average measurements \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.998 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.997 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.999 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">509.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">105 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">105 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3512430.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Intraclass Correlation Coefficient between Evaluator 1 and Evaluator 2.</p>" ] ] 6 => array:5 [ "identificador" => "fig0030" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 1012 "Ancho" => 2056 "Tamanyo" => 69042 ] ] ] 7 => array:5 [ "identificador" => "tb0005" "tipo" => "MULTIMEDIATEXTO" "mostrarFloat" => false "mostrarDisplay" => true "texto" => array:1 [ "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec9005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect5065">What is known?</span><p id="par0010" class="elsevierStylePara elsevierViewall">Obtaining body height in the intensive care unit is essential to calculate ideal body weight; and this, in turn, to calculate the tidal volume of the mechanical ventilator. At present, protocols to accurately obtain this measurement are not described in the literature.</p></span><span id="sec1010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect4070">What is the contribution of this?</span><p id="par0020" class="elsevierStylePara elsevierViewall">A new protocol for obtaining body height in intensive care, using accessible and portable tools; which will contribute to standardizing this measurement, minimizing errors and improving the clinical practice of professionals who work in this field.</p></span></span>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The weight debate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.J. 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