Effects of respiratory rehabilitation on patients after extubation
The purpose of this study is to evaluate whether sequential treatment with high-flow humidification therapy apparatus can improve the postoperative recovery and functional status of patients with invasive mechanical ventilation in ICU after the withdrawal of the catheter.Inclusion criteria: age 18-95;The hemodynamics were stable, that is, 50 \< heart rate less than 120 beats/min, 90 \< systolic blood pressure \< 200mmHg, 55 \< mean arterial pressure \< 120mmHg.Do not increase the dose of vasopressor for at least 2 hours;Intracranial pressure was stable and there was no seizure within 24 hours.The breathing condition was stable, that is, the oxygen satiety of the patient's finger vein was ≥88%, and the breathing frequency was \>10 and\< 35 times/min.Exclusion criteria: pregnancy;Acute myocardial infarction.A total of 50 patients who are sequentially treated with high-flow humidification therapy apparatus after extubation in ICU are randomly assigned. The experimental group receive respiratory rehabilitation therapy, while the control group only receive routine medical treatment. All the enrolled patients underwent rehabilitation evaluation and bedside diaphragmatic ultrasound measurement.This study was approved by the Ethics Committee of the CPLA General Hospital (project No.2018-212-01). The following clinical datas were recorded for all patients through the unified database software: The rehabilitation program was formulated according to the cluster management strategy of ABCDEF and the six-step method of early activities.All of the patients in monitoring vital signs, every day at hospital group and all peripheral muscle MRC assessment, 30 s sit stand trial, modified Barthel index, Borg dyspnea score, arterial blood gas analysis, diaphragm ultrasonic monitoring by the bed, finally the experimental process on the patients whether using noninvasive ventilator, whether for endotracheal intubation again, whether to have new complications (pressure sores, aspiration, thrombosis, etc.) and the patients bed time statistics for the first time. Statistical analyses were conducted by SPSS 21.0 and a two-tailed P \< 0.05 was considered significant.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
100
Pulmonary rehabilitation (respiratory rehabilitation) is a comprehensive intervention based on a comprehensive patient assessment, targeted to the treatment of patients, including but not limited to exercise training, education and behavior change, aimed at improving the physical and mental health of patients with chronic respiratory diseases and promoting long-term adherence to health-enhancing behaviors.
Reintubation rates
The artificial airway was established again for invasive mechanical ventilation
Time frame: 28 days
MRC,medical research council
medical research council,Assessment of peripheral muscle strength,total points0\~60,less than 48scores means ICU aquired weaknesses.
Time frame: 28 days
30-STS
30 second sit-to-stand test.The more times, has the better muscular endurance.
Time frame: 28 days
Barthel
Assessment of activities of daily living.total points0\~100,less than 60 scores means can't independent living.
Time frame: 28 days
Borg dyspnea score
total points0\~10,The higher the grade, the more difficulty breathing.
Time frame: 28 days
oxygen partial pressure
Partial pressure of oxygen in arterial blood,normal range is 80\~100.
Time frame: 28 days
oxygenation index
The partial pressure of oxygen divided by the concentration of oxygen,Normal is greater than 400.
Time frame: 28 days
The diaphragmatic excursion
The distance the diaphragm moves up and down during breathing,normal is 1.4cm.
Time frame: 28 days
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diaphragm contraction rate
The rate at which the diaphragm contracts during breathing,normal is 1.3cm/s.
Time frame: 28 days
diaphragm thickness diaphragm thickness fraction
Thickness of diaphragm during breathing,(Diaphragm thickness at the end of inhalation-Diaphragm thickness at the end of exhalation)/Diaphragm thickness at the end of exhalation
Time frame: 28 days
length of stay in ICU
Length of stay in ICU
Time frame: three months
LOS(length of stay)
length of stay in hospital
Time frame: three months
First time out of bed
First time out of bed by oneself
Time frame: three months
Noninvasive utilization rate
Non-invasive ventilator usage
Time frame: 28 days
mortality
Alive or Dead
Time frame: 28 days
Complication rate
The incidence of new complications(pressure sores、thrombus、aspiration)
Time frame: 28 days