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：

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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, 周朝陽, 等. eCASH策略預防ICU機械通氣患者譫妄效果評價. 護理學雜志, 2019, 34(20): 27-30.
3.	中華醫學會呼吸病學分會感染學組. 中國成人醫院獲得性肺炎與呼吸機相關性肺炎診斷和治療指南(2018年版). 中華結核和呼吸雜志, 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, 黃雪敏, 岑樹坤, 等. 早期康復治療對老年重癥肺炎機械通氣患者并發癥及預后的影響. 中國呼吸與危重監護雜志, 2018, 17(1): 46-50.
8.	孫暉, 趙娜, 于婷婷, 等. ICU有創機械通氣COPD患者早期肺康復的研究進展. 德州學院學報, 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.	楊富, 方芳, 陳蘭, 等. 早期漸進式康復方案對SICU機械通氣患者術后康復的影響. 護士進修雜志, 2019, 34(16): 1502-1505.
11.	中國康復醫學會重癥康復專業委員會呼吸重癥康復學組, 中國老年保健醫學研究會老齡健康服務與標準化分會, 《中國老年保健醫學》雜志編輯委員會, 等. 中國呼吸重癥康復治療技術專家共識. 中國老年保健醫學, 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.	何麗, 周玲玲. 探究ICU機械通氣患者心理狀態及心理干預對預后的影響. 中國健康心理學雜志, 2018, 26(12): 1791-1794.
14.	中華醫學會重癥醫學分會. 中國成人ICU鎮痛和鎮靜治療指南. 中華危重病急救醫學, 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.	徐建橋, 溫若譞, 趙瑛, 等. 長期機械通氣患者膈肌功能的超聲評估研究. 中華結核和呼吸雜志, 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.	陳虹錚, 韓亮, 焦江博, 等. 兩種呼吸肌肌力評定方法對腦卒中患者的應用及相關性研究. 臨床醫藥文獻電子雜志, 2020, 7(4): 17-20.
24.	鄧娜, 鄭青玉. 運動療法在呼吸機依賴患者撤機中的應用效果. 實用臨床醫學, 2016, 17(9): 59-60.
25.	賀慧為, 何招輝, 王榮勝, 等. 肺部超聲在急性呼吸窘迫綜合征患者肺復張治療中的應用. 中國呼吸與危重監護雜志, 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, 周朝陽, 等. eCASH策略預防ICU機械通氣患者譫妄效果評價. 護理學雜志, 2019, 34(20): 27-30.
3. 中華醫學會呼吸病學分會感染學組. 中國成人醫院獲得性肺炎與呼吸機相關性肺炎診斷和治療指南(2018年版). 中華結核和呼吸雜志, 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, 黃雪敏, 岑樹坤, 等. 早期康復治療對老年重癥肺炎機械通氣患者并發癥及預后的影響. 中國呼吸與危重監護雜志, 2018, 17(1): 46-50.
8. 孫暉, 趙娜, 于婷婷, 等. ICU有創機械通氣COPD患者早期肺康復的研究進展. 德州學院學報, 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. 楊富, 方芳, 陳蘭, 等. 早期漸進式康復方案對SICU機械通氣患者術后康復的影響. 護士進修雜志, 2019, 34(16): 1502-1505.
11. 中國康復醫學會重癥康復專業委員會呼吸重癥康復學組, 中國老年保健醫學研究會老齡健康服務與標準化分會, 《中國老年保健醫學》雜志編輯委員會, 等. 中國呼吸重癥康復治療技術專家共識. 中國老年保健醫學, 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. 何麗, 周玲玲. 探究ICU機械通氣患者心理狀態及心理干預對預后的影響. 中國健康心理學雜志, 2018, 26(12): 1791-1794.
14. 中華醫學會重癥醫學分會. 中國成人ICU鎮痛和鎮靜治療指南. 中華危重病急救醫學, 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. 徐建橋, 溫若譞, 趙瑛, 等. 長期機械通氣患者膈肌功能的超聲評估研究. 中華結核和呼吸雜志, 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. 陳虹錚, 韓亮, 焦江博, 等. 兩種呼吸肌肌力評定方法對腦卒中患者的應用及相關性研究. 臨床醫藥文獻電子雜志, 2020, 7(4): 17-20.
24. 鄧娜, 鄭青玉. 運動療法在呼吸機依賴患者撤機中的應用效果. 實用臨床醫學, 2016, 17(9): 59-60.
25. 賀慧為, 何招輝, 王榮勝, 等. 肺部超聲在急性呼吸窘迫綜合征患者肺復張治療中的應用. 中國呼吸與危重監護雜志, 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

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