Diaphragm dysfunction, ineffective chest wall and respiratory muscle function are frequently observed in critically ill patients with difficult weaning from mechanical ventilation(MV).It is the leading cause of retention of airway secretions and insufficient airway clearance.Thechest physiotherapy (CPT) of critically ill patients can reduce secretion retention. We designed a protocol to investigate the feasibility and efficacy of CPT guided by electrical impedance tomography (EIT) in Difficult-to-Wean patients.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
80
Two sessions of CPT (morning and afternoon, 20 minutes each) were conducted. The CPT session consisted of modified postural drainage, assisted cough technique , positive expiratory pressure and chest percussion, vibration. The appointed therapist performed pulmonary auscultation and thoracic palpation to assess the status of pulmonary ventilation and secretion retention, and whether the patient's cough ability can complete effective airway clearance. Individualized program was formed according to the assessment, internal guidelines, the patient's tolerance, education level, and patient's preference prior to the randomization. All CPT sessions were performed by the same physiotherapist to avoid potential bias.
EIT-guided modified postural drainage combined with vibrations and chest percussion: tidal variation images in EIT reveals heterogeneously ventilated regions. Physiotherapist identified such regions at the bedside and instructed the patient to take the appropriate drainage position, so that the poorly ventilated regions became gravity non-dependent regions. Subsequently, the physiotherapist put her hands on the poorly ventilated area with a vibratory force. A compressive pressure was produced by the therapist's arms.
peak expiratory flow
Time frame: All data will be recorded at the baseline (T1), 14 days (T2) and 28 days (T3)
The cumulative incidence of successful weaning by Day 30
Time frame: from admission to discharge, assessed up to 1 day
Maximum inspiratory pressure
Time frame: All data will be recorded at the baseline (T1), 14 days (T2) and 28 days (T3)
Diaphragm thickening rate
Time frame: All data will be recorded at the baseline (T1), 14 days (T2) and 28 days (T3)
Diaphragmatic excursion
Time frame: All data will be recorded at the baseline (T1), 14 days (T2) and 28 days (T3)
Length of ICU stay
Time frame: from admission to discharge, assessed up to 1 day
Cumulative incidence for death before successful weaning
Time frame: from admission to discharge, assessed up to 1 day
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