Effect of early graded respiratory severe rehabilitation training for patients with mechanical ventilation under multidisciplinary cooperation mode_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIU Gang ¹ ,  HU Shaohua ¹ , DUAN Zonghao ² , XU Fengling ¹ , XIA Min ¹ , NI Xiumei ¹

1. The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

HU Shaohua, Email: hushaohua1003@126.com

Keywords：

Respiratory severe rehabilitation training; Multidisciplinary; Diaphragm; Mechanical ventilation

DOI：

10.7507/1671-6205.202011068

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the effect of early graded respiratory severe rehabilitation training for patients with mechanical ventilation under a multidisciplinary model.Methods Two hundred and thirty-six patients were surveyed, who were hospitalized in the intensive care unit of the First Affiliated Hospital of Anhui Medical University from June 3, 2019 to March 31, 2020. They were randomly divided into an observation group and a control group, with 118 patients in each group. The observation group received rehabilitation training using early graded rehabilitation training under the mode of multidisciplinary cooperation, while the control group received routine respiratory rehabilitation training. Diaphragmatic excursion (DE) and diaphragmatic thickening fraction (DTF) of the patients before ventilator weaning were measured by ultrasound. The differences of DE, DTF, peak expiratory flow (PEF), maximal inspiratory pressure (MIP), success rate of withdrawal, duration of mechanical ventilation and intensive care unit (ICU) stay between the two groups were recorded and compared.Results All evaluation indexes were statistically significant between the observation group and the control group (all P<0.05). There were interaction between oxygenation index, PEF, MIP, Acute Physiology and Chronic Health Score, Clinical Pulmonary Infection Score and recovery time.Conclusion Rehabilitation training on early graded severe respiratory diseases under a multidisciplinary model can improve the respiratory function of patients on mechanical ventilation and shorten the duration of mechanical ventilation and ICU stay.

Citation： LIU Gang, HU Shaohua, DUAN Zonghao, XU Fengling, XIA Min, NI Xiumei. Effect of early graded respiratory severe rehabilitation training for patients with mechanical ventilation under multidisciplinary cooperation mode. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(4): 254-260. doi: 10.7507/1671-6205.202011068 Copy

1.	Metersky ML, Kalil AC. Management of Ventilator-Associated Pneumonia: Guidelines. Clin Chest Med, 2018, 39(4): 797-808.
2.	成晶, 席明霞, 周朝阳, 等. eCASH策略预防ICU机械通气患者谵妄效果评价. 护理学杂志, 2019, 34(20): 27-30.
3.	中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版). 中华结核和呼吸杂志, 2018, 41(4): 255-280.
4.	Morris PE, Berry MJ, Files DC, et al. Standardized rehabilitation and hospital length of stay among patients with acute respiratory failure: a randomized clinical trial. JAMA, 2016, 315(24): 2694-2702.
5.	Green M, Marzano V, Leditschke IA, et al. Mobilization of intensive care patients: a multidisciplinary practical guide for clinicians. J Multidiscip Healthc, 2016, 25(9): 247-256.
6.	Kramer CL. Intensive care unit-acquired weakness. Neurol Clin, 2017, 35(4): 723-736.
7.	李大亮, 黄雪敏, 岑树坤, 等. 早期康复治疗对老年重症肺炎机械通气患者并发症及预后的影响. 中国呼吸与危重监护杂志, 2018, 17(1): 46-50.
8.	孙晖, 赵娜, 于婷婷, 等. ICU有创机械通气COPD患者早期肺康复的研究进展. 德州学院学报, 2019, 35(2): 37-40.
9.	Schaller SJ, Anstey M, Blobner M, et al. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet, 2016, 388(10052): 1377-1388.
10.	杨富, 方芳, 陈兰, 等. 早期渐进式康复方案对SICU机械通气患者术后康复的影响. 护士进修杂志, 2019, 34(16): 1502-1505.
11.	中国康复医学会重症康复专业委员会呼吸重症康复学组, 中国老年保健医学研究会老龄健康服务与标准化分会, 《中国老年保健医学》杂志编辑委员会, 等. 中国呼吸重症康复治疗技术专家共识. 中国老年保健医学, 2018, 16(5): 3-11.
12.	Ely EW, Truman B, Shintani A, et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA, 2003, 289(22): 2983-2991.
13.	何丽, 周玲玲. 探究ICU机械通气患者心理状态及心理干预对预后的影响. 中国健康心理学杂志, 2018, 26(12): 1791-1794.
14.	中华医学会重症医学分会. 中国成人ICU镇痛和镇静治疗指南. 中华危重病急救医学, 2018, 30(6): 497-514.
15.	Knaus WA, Draper EA, Wagner DP, et al. APACHE Ⅱ: a severity of disease classification system. Crit Care Med, 1985, 13(10): 818-829.
16.	Pugin J, Auckenthaler R, Mili N, et al. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic "blind" bronchoalveolar lavage fluid. Am Rev Respir Dis, 1991, 143(5 Pt 1): 1121-1129.
17.	Rochester CL. Patient assessment and selection for pulmonary rehabilitation. Respirology, 2019, 24(9): 844-853.
18.	Schepens T, Verbrugghe W, Dams K, et al. The course of diaphragm atrophy in ventilated patients assessed with ultrasound: a longitudinal cohort study. Crit Care, 2015, 19(1): 422-429.
19.	Pirompanich P, Romsaiyut S. Use of diaphragm thickening fraction combined with rapid shallow breathing index for predicting success of weaning from mechanical ventilator in medical patients. J Intensive Care, 2018, 6: 6.
20.	徐建桥, 温若譞, 赵瑛, 等. 长期机械通气患者膈肌功能的超声评估研究. 中华结核和呼吸杂志, 2020, 43(2): 132-135.
21.	Magalhes P, Camillo CA, Langer D, et al. Weaning failure and respiratory muscle function: what has been done and what can be improved?. Respir Med, 2018, 134(1): 54-61.
22.	Chen YH, Lin HL, Hsiao HF, et al. Effects of exercise training on pulmonary mechanics and functional status in patients with prolonged mechanical ventilation. Respiratory Care, 2012, .57(5): 727-734.
23.	陈虹铮, 韩亮, 焦江博, 等. 两种呼吸肌肌力评定方法对脑卒中患者的应用及相关性研究. 临床医药文献电子杂志, 2020, 7(4): 17-20.
24.	邓娜, 郑青玉. 运动疗法在呼吸机依赖患者撤机中的应用效果. 实用临床医学, 2016, 17(9): 59-60.
25.	贺慧为, 何招辉, 王荣胜, 等. 肺部超声在急性呼吸窘迫综合征患者肺复张治疗中的应用. 中国呼吸与危重监护杂志, 2017, 16(6): 591-594.
26.	Powers SK, Kavazis AN, Levine S. Prolonged mechanical ventilation alters diaphragmatic structure and function. Crit Care Med, 2009, 37(10 Suppl): 347-353.
27.	Hudson MB, Smuder AJ, Nelson WB, et al. Both high level pressure support ventilation and controlled mechanical ventilation induce diaphragm dysfunction and atrophy. Crit Care Med, 2012, 40(4): 1254-1260.
28.	Paddon-Jones D, Sheffield-Moore M, Urban RJ, et al. Essential amino acid and carbohydrate supplementation ameliorates muscle protein loss in humans during 28 days bedrest. J Clin Endocrinol Metab, 2004, 89(9): 4351-4358.
29.	Fadiloglu E, Bulut Yuksel ND, Unal C, et al. Characteristics of obstetric admissions to intensive care unit: APACHE Ⅱ, SOFA and the Glasgow Coma Scale. J Perinat Med, 2019, 47(9): 947-957.

1. Metersky ML, Kalil AC. Management of Ventilator-Associated Pneumonia: Guidelines. Clin Chest Med, 2018, 39(4): 797-808.
2. 成晶, 席明霞, 周朝阳, 等. eCASH策略预防ICU机械通气患者谵妄效果评价. 护理学杂志, 2019, 34(20): 27-30.
3. 中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版). 中华结核和呼吸杂志, 2018, 41(4): 255-280.
4. Morris PE, Berry MJ, Files DC, et al. Standardized rehabilitation and hospital length of stay among patients with acute respiratory failure: a randomized clinical trial. JAMA, 2016, 315(24): 2694-2702.
5. Green M, Marzano V, Leditschke IA, et al. Mobilization of intensive care patients: a multidisciplinary practical guide for clinicians. J Multidiscip Healthc, 2016, 25(9): 247-256.
6. Kramer CL. Intensive care unit-acquired weakness. Neurol Clin, 2017, 35(4): 723-736.
7. 李大亮, 黄雪敏, 岑树坤, 等. 早期康复治疗对老年重症肺炎机械通气患者并发症及预后的影响. 中国呼吸与危重监护杂志, 2018, 17(1): 46-50.
8. 孙晖, 赵娜, 于婷婷, 等. ICU有创机械通气COPD患者早期肺康复的研究进展. 德州学院学报, 2019, 35(2): 37-40.
9. Schaller SJ, Anstey M, Blobner M, et al. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet, 2016, 388(10052): 1377-1388.
10. 杨富, 方芳, 陈兰, 等. 早期渐进式康复方案对SICU机械通气患者术后康复的影响. 护士进修杂志, 2019, 34(16): 1502-1505.
11. 中国康复医学会重症康复专业委员会呼吸重症康复学组, 中国老年保健医学研究会老龄健康服务与标准化分会, 《中国老年保健医学》杂志编辑委员会, 等. 中国呼吸重症康复治疗技术专家共识. 中国老年保健医学, 2018, 16(5): 3-11.
12. Ely EW, Truman B, Shintani A, et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA, 2003, 289(22): 2983-2991.
13. 何丽, 周玲玲. 探究ICU机械通气患者心理状态及心理干预对预后的影响. 中国健康心理学杂志, 2018, 26(12): 1791-1794.
14. 中华医学会重症医学分会. 中国成人ICU镇痛和镇静治疗指南. 中华危重病急救医学, 2018, 30(6): 497-514.
15. Knaus WA, Draper EA, Wagner DP, et al. APACHE Ⅱ: a severity of disease classification system. Crit Care Med, 1985, 13(10): 818-829.
16. Pugin J, Auckenthaler R, Mili N, et al. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic "blind" bronchoalveolar lavage fluid. Am Rev Respir Dis, 1991, 143(5 Pt 1): 1121-1129.
17. Rochester CL. Patient assessment and selection for pulmonary rehabilitation. Respirology, 2019, 24(9): 844-853.
18. Schepens T, Verbrugghe W, Dams K, et al. The course of diaphragm atrophy in ventilated patients assessed with ultrasound: a longitudinal cohort study. Crit Care, 2015, 19(1): 422-429.
19. Pirompanich P, Romsaiyut S. Use of diaphragm thickening fraction combined with rapid shallow breathing index for predicting success of weaning from mechanical ventilator in medical patients. J Intensive Care, 2018, 6: 6.
20. 徐建桥, 温若譞, 赵瑛, 等. 长期机械通气患者膈肌功能的超声评估研究. 中华结核和呼吸杂志, 2020, 43(2): 132-135.
21. Magalhes P, Camillo CA, Langer D, et al. Weaning failure and respiratory muscle function: what has been done and what can be improved?. Respir Med, 2018, 134(1): 54-61.
22. Chen YH, Lin HL, Hsiao HF, et al. Effects of exercise training on pulmonary mechanics and functional status in patients with prolonged mechanical ventilation. Respiratory Care, 2012, .57(5): 727-734.
23. 陈虹铮, 韩亮, 焦江博, 等. 两种呼吸肌肌力评定方法对脑卒中患者的应用及相关性研究. 临床医药文献电子杂志, 2020, 7(4): 17-20.
24. 邓娜, 郑青玉. 运动疗法在呼吸机依赖患者撤机中的应用效果. 实用临床医学, 2016, 17(9): 59-60.
25. 贺慧为, 何招辉, 王荣胜, 等. 肺部超声在急性呼吸窘迫综合征患者肺复张治疗中的应用. 中国呼吸与危重监护杂志, 2017, 16(6): 591-594.
26. Powers SK, Kavazis AN, Levine S. Prolonged mechanical ventilation alters diaphragmatic structure and function. Crit Care Med, 2009, 37(10 Suppl): 347-353.
27. Hudson MB, Smuder AJ, Nelson WB, et al. Both high level pressure support ventilation and controlled mechanical ventilation induce diaphragm dysfunction and atrophy. Crit Care Med, 2012, 40(4): 1254-1260.
28. Paddon-Jones D, Sheffield-Moore M, Urban RJ, et al. Essential amino acid and carbohydrate supplementation ameliorates muscle protein loss in humans during 28 days bedrest. J Clin Endocrinol Metab, 2004, 89(9): 4351-4358.
29. Fadiloglu E, Bulut Yuksel ND, Unal C, et al. Characteristics of obstetric admissions to intensive care unit: APACHE Ⅱ, SOFA and the Glasgow Coma Scale. J Perinat Med, 2019, 47(9): 947-957.

Chinese Journal of Respiratory and Critical Care Medicine

Effect of early graded respiratory severe rehabilitation training for patients with mechanical ventilation under multidisciplinary cooperation mode

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content